Undergraduate medical students’ readiness for online learning at a South African university: Implications for decentralised training

Background. Decentralised teaching has the potential to transform medical education but requires greater use of online learning to address some of the challenges of decentralised teaching in low- and middle-income countries. Given the digital divide that exists in South Africa (SA), it is necessary to establish the extent of student readiness for the broader implementation of online learning. Objectives. To determine medical students’ device ownership, usage and attitudes towards online learning at the University of the Witwatersrand, Johannesburg. Methods. A cross-sectional survey of first-, third- and sixth-year students was conducted in 2017. The questionnaire included open- and closed-ended questions. Quantitative data were analysed using frequency and custom tables and Kruskal-Wallis one-way analysis of variance (ANOVA) tests. Open-ended responses were analysed using content analysis. Results. The survey response rate was 48.5% (448/924). No significant differences in device usage and attitudes towards online learning were observed across the 3 years of study. Most respondents (99%) owned internet-capable devices, and >90% wanted some degree of online learning. The perceived barriers included poor internet connectivity on university campuses and the high cost of data in SA. Conclusion. The majority of respondents owned internet-capable devices and requested more online learning, but the socioeconomic disparities in the country raise concerns about students’ readiness. Wider online learning requires policy decisions to ensure not only access to devices and data but also the implementation of online learning in ways that avoid further disadvantaging already disadvantaged students. Institutional barriers must be addressed before an expanded online learning environment can be considered

Feeling good about being hungry: food-related thoughts in eating disorder

Objectives: This study explores the relationships to food and hunger in women living with anorexic type eating difficulties and asks how imagery-based elaborations of food and eating thoughts are involved in their eating restraint, and recovery. Design: The qualitative idiographic approach of Interpretative Phenomenological Analysis (IPA) was used. Four in-depth semi-structured interviews were conducted with women self-selected as having experienced anorexia or anorexic like behaviour. Methods: The data was analysed using IPA and an audit of the analysis was conducted to ensure that the process followed had been systematic and rigorous and appropriately considered reflexivity. Results: Hunger was perceived positively by participants as confirmation that they were achieving their goal of losing weight, or avoiding weight gain. Hunger conferred a sense of being in control for the participants. Intrusive thoughts about food were reported as being quickly followed by elaborative mental imagery of the positive aspects of weight loss, and the negative consequences of eating. Imagery appeared to serve to maintain anorexic behaviours rather than to motivate food seeking. However, negative imagery of the consequences of anorexia were also described as supporting recovery. Conclusions: The finding that physiological sensations of hunger were experienced as positive confirmation of maintaining control has potentially important clinical and theoretical implications. It suggests further attention needs to be focused upon how changes in cognitive elaboration, involving mental imagery, are components of the psychological changes in the development of, maintenance of, and recovery from, anorexia

Reply: SUN vs BEVþIFN in first-line mRCC therapy: no evidence for a statistically significant difference in progression-free survival

Copyright © 2015 Cancer Research UKThis is an BJC Open articleLetter to the Edito

Undergraduate medical students’ readiness for online learning at a South African university: Implications for decentralised training

Background. Decentralised teaching has the potential to transform medical education but requires greater use of online learning to address some of the challenges of decentralised teaching in low- and middle-income countries. Given the digital divide that exists in South Africa (SA), it is necessary to establish the extent of student readiness for the broader implementation of online learning.  Objectives. To determine medical students’ device ownership, usage and attitudes towards online learning at the University of the Witwatersrand, Johannesburg.  Methods. A cross-sectional survey of first-, third- and sixth-year students was conducted in 2017. The questionnaire included open- and closed-ended questions. Quantitative data were analysed using frequency and custom tables and Kruskal-Wallis one-way analysis of variance (ANOVA) tests. Open-ended responses were analysed using content analysis.  Results. The survey response rate was 48.5% (448/924). No significant differences in device usage and attitudes towards online learning were observed across the 3 years of study. Most respondents (99%) owned internet-capable devices, and >90% wanted some degree of online learning. The perceived barriers included poor internet connectivity on university campuses and the high cost of data in SA.  Conclusion. The majority of respondents owned internet-capable devices and requested more online learning, but the socioeconomic disparities in the country raise concerns about students’ readiness. Wider online learning requires policy decisions to ensure not only access to devices and data but also the implementation of online learning in ways that avoid further disadvantaging already disadvantaged students. Institutional barriers must be addressed before an expanded online learning environment can be considered

A Parametric Study of Erupting Flux Rope Rotation. Modeling the "Cartwheel CME" on 9 April 2008

The rotation of erupting filaments in the solar corona is addressed through a parametric simulation study of unstable, rotating flux ropes in bipolar force-free initial equilibrium. The Lorentz force due to the external shear field component and the relaxation of tension in the twisted field are the major contributors to the rotation in this model, while reconnection with the ambient field is of minor importance. Both major mechanisms writhe the flux rope axis, converting part of the initial twist helicity, and produce rotation profiles which, to a large part, are very similar in a range of shear-twist combinations. A difference lies in the tendency of twist-driven rotation to saturate at lower heights than shear-driven rotation. For parameters characteristic of the source regions of erupting filaments and coronal mass ejections, the shear field is found to be the dominant origin of rotations in the corona and to be required if the rotation reaches angles of order 90 degrees and higher; it dominates even if the twist exceeds the threshold of the helical kink instability. The contributions by shear and twist to the total rotation can be disentangled in the analysis of observations if the rotation and rise profiles are simultaneously compared with model calculations. The resulting twist estimate allows one to judge whether the helical kink instability occurred. This is demonstrated for the erupting prominence in the "Cartwheel CME" on 9 April 2008, which has shown a rotation of \approx 115 degrees up to a height of 1.5 R_sun above the photosphere. Out of a range of initial equilibria which include strongly kink-unstable (twist Phi=5pi), weakly kink-unstable (Phi=3.5pi), and kink-stable (Phi=2.5pi) configurations, only the evolution of the weakly kink-unstable flux rope matches the observations in their entirety.Comment: Solar Physics, submitte

The Birmingham Boron Neutron Capture Therapy (BNCT) project : developments towards selective internal particle therapy

This paper will review progress on two aspects of the Birmingham BNCT project. Firstly on evaluation of the effects of high and low LET radiations when delivered simultaneously, and secondly on attempts to optimise delivery of the boron carrier compound BPA through pharmacokinetic studies. Simultaneous or non-simultaneous irradiations of V79 cells with alpha-particle and X-ray irradiations were performed. Alpha doses of 2 and 2.5 Gy were chosen and the impact on survival when delivered separately or simultaneously with variable doses of X-rays was evaluated. The pharmacokinetics of the delivery of a new formulation of BPA (BPA-mannitol) are being investigated in brain tumour patients through a study with 2 × 2 design featuring intravenous and intracarotid artery infusion of BPA, with or without a mannitol bolus. On the combined effect of low and high LET radiations, a synergistic effect was observed when alpha and X-ray doses are delivered simultaneously. The effect is only present at the 2.5 Gy alpha dose and is a very substantial effect on both the shape of the survival curve and the level of cell killing. This indicates that the alpha component may have the effect of inhibiting the repair of damage from the low LET radiation dose delivered simultaneously. On the pharmacokinetics of BPA, data on the first three cohorts indicate that bioavailability of BPA in brain ECF is increased substantially through the addition of a mannitol bolus, as well as by the use of intracarotid artery route of infusion. In both cases, for some patients the levels after infusion approach those seen in blood, whereas the ECF levels for intravenous infusion without mannitol are typically less than 10% of the blood values

Bevacizumab, sorafenib tosylate, sunitinib and temsirolimus for renal cell carcinoma: a systematic review and economic evaluation

addresses: Peninsula Technology Assessment Group, Peninsula College of Medicine and Dentistry, University of Exeter, UK.types: Journal Article; ReviewPublished version. Copyright © 2010 NIHR Health Technology Assessment ProgrammeTo assess the clinical effectiveness and cost-effectiveness of bevacizumab, combined with interferon (IFN), sorafenib tosylate, sunitinib and temsirolimus in the treatment of people with advanced and/or metastatic renal cell carcinoma (RCC)

Transfer RNA-derived small RNAs in the cancer transcriptome

The cellular lifetime includes stages such as differentiation, proliferation, division, senescence and apoptosis.These stages are driven by a strictly ordered process of transcription dynamics. Molecular disruption to RNA polymerase assembly, chromatin remodelling and transcription factor binding through to RNA editing, splicing, post-transcriptional regulation and ribosome scanning can result in significant costs arising from genome instability. Cancer development is one example of when such disruption takes place. RNA silencing is a term used to describe the effects of post-transcriptional gene silencing mediated by a diverse set of small RNA molecules. Small RNAs are crucial for regulating gene expression and microguarding genome integrity.RNA silencing studies predominantly focus on small RNAs such as microRNAs, short-interfering RNAs and piwi-interacting RNAs. We describe an emerging renewal of inter-est in a‘larger’small RNA, the transfer RNA (tRNA).Precisely generated tRNA-derived small RNAs, named tRNA halves (tiRNAs) and tRNA fragments (tRFs), have been reported to be abundant with dysregulation associated with cancer. Transfection of tiRNAs inhibits protein translation by displacing eukaryotic initiation factors from messenger RNA (mRNA) and inaugurating stress granule formation.Knockdown of an overexpressed tRF inhibits cancer cell proliferation. Recovery of lacking tRFs prevents cancer metastasis. The dual oncogenic and tumour-suppressive role is typical of functional small RNAs. We review recent reports on tiRNA and tRF discovery and biogenesis, identification and analysis from next-generation sequencing data and a mechanistic animal study to demonstrate their physiological role in cancer biology. We propose tRNA-derived small RNA-mediated RNA silencing is an innate defence mechanism to prevent oncogenic translation. We expect that cancer cells are percipient to their ablated control of transcription and attempt to prevent loss of genome control through RNA silencing

Extended warm and dense gas towards W49A: starburst conditions in our Galaxy?

The star formation rates in starburst galaxies are orders of magnitude higher than in local star-forming regions, and the origin of this difference is not well understood. We use sub-mm spectral line maps to characterize the physical conditions of the molecular gas in the luminous Galactic star-forming region W49A and compare them with the conditions in starburst galaxies. We probe the temperature and density structure of W49A using H_2CO and HCN line ratios over a 2'x2' (6.6x6.6 pc) field with an angular resolution of 15" (~0.8 pc) provided by the JCMT Spectral Legacy Survey. We analyze the rotation diagrams of lines with multiple transitions with corrections for optical depth and beam dilution, and estimate excitation temperatures and column densities. Comparing the observed line intensity ratios with non-LTE radiative transfer models, our results reveal an extended region (about 1'x1', equivalent to ~3x3 pc at the distance of W49A) of warm (> 100 K) and dense (>10^5 cm^-3) molecular gas, with a mass of 2x10^4 - 2x10^5 M_Sun (by applying abundances derived for other regions of massive star-formation). These temperatures and densities in W49A are comparable to those found in clouds near the center of the Milky Way and in starburst galaxies. The highly excited gas is likely to be heated via shocks from the stellar winds of embedded, O-type stars or alternatively due to UV irradiation, or possibly a combination of these two processes. Cosmic rays, X-ray irradiation and gas-grain collisional heating are less likely to be the source of the heating in the case of W49A.Comment: Accepted for publication in A&A; 11 pages, 9 figure

Adverse prognostic and predictive significance of low DNA-dependent protein kinase catalytic subunit (DNA-PKcs) expression in early-stage breast cancers

Background: DNA-dependent protein kinase catalytic subunit (DNA-PKcs), a serine threonine kinase belonging to the PIKK family (phosphoinositide 3-kinase-like-family of protein kinase), is a critical component of the non-homologous end joining (NHEJ) pathway required for the repair of DNA double strand breaks. DNA-PKcs may be involved in breast cancer pathogenesis. Methods: We evaluated clinicopathological significance of DNA-PKcs protein expression in 1161 tumours and DNA-PKcs mRNA expression in 1950 tumours. We correlated DNA-PKcs to other markers of aggressive phenotypes, DNA repair, apoptosis and cell cycle regulation. Results: Low DNA-PKcs protein expression was associated with higher tumour grade, higher mitotic index, tumour de-differentiation and tumour type (ps<0.05). Absence of BRCA1, low XRCC1/SMUG1/APE1/Polβ were also more likely in low DNA-PKcs expressing tumours (ps<0.05). Low DNA-PKcs protein expression was significantly associated with worse breast cancer specific survival (BCCS) in univariate and multivariate analysis (ps<0.01). At the mRNA level, low DNA-PKcs was associated with PAM50.Her2 and PAM50.LumA molecular phenotypes (ps<0.01) and poor BCSS. In patients with ER positive tumours who received endocrine therapy, low DNA-PKcs (protein and mRNA) was associated with poor survival. In ER negative patients, low DNA-PKcs mRNA remains significantly associated with adverse outcome. Conclusions: Our study suggests that low DNA-PKcs expression may have prognostic and predictive significance in breast cancers