THE VIRTUAL TEACHING HOSPITAL SYSTEM (VTHS)

As their course progresses, medical students amass a vast amount of information but must, crucially, develop the skills of diagnosis and patient management. Such skills, learnt at the bedside, necessitate a great deal of time-consuming clinical oversight. The ˜Virtual Teaching Hospital System" (VTHS), is essentially a computer-assisted diagnostic system, designed to enable unlimited, unsupervised practise of clerking and diagnosing patients, using real or simulated data. Developed in VB6.0 by Dr Omara, VTHS has been transformed to C-Sharp and PHP by the MCS Department.  It has been re-engineered for compatibility with the Medical School's current clinical teaching policy, has focussed initially on a range of respiratory diseases, and is ready for evaluation by medical students. It will be evaluated for impact on medical student group learning in Leicester and, if possible, more widely in the UK. It has broader potential for the improvement of health care in developing countries, including Ethiopia and others in sub-Saharan Africa. Donors such as WHO, UNICEF, SIDA and UNAIDS may sponsor the use of the program, in the fight against HIV/AIDS, and infant and maternal mortality. VTHS was demonstrated to her Majesty the Queen on her recent visit and Elsevier have subsequently made enquiries

THE VIRTUAL TEACHING HOSPITAL SYSTEM (VTHS)

As their course progresses, medical students amass a vast amount of information but must, crucially, develop the skills of diagnosis and patient management. Such skills, learnt at the bedside, necessitate a great deal of time-consuming clinical oversight. The ˜Virtual Teaching Hospital System" (VTHS), is essentially a computer-assisted diagnostic system, designed to enable unlimited, unsupervised practise of clerking and diagnosing patients, using real or simulated data. Developed in VB6.0 by Dr Omara, VTHS has been transformed to C-Sharp and PHP by the MCS Department.  It has been re-engineered for compatibility with the Medical School's current clinical teaching policy, has focussed initially on a range of respiratory diseases, and is ready for evaluation by medical students. It will be evaluated for impact on medical student group learning in Leicester and, if possible, more widely in the UK. It has broader potential for the improvement of health care in developing countries, including Ethiopia and others in sub-Saharan Africa. Donors such as WHO, UNICEF, SIDA and UNAIDS may sponsor the use of the program, in the fight against HIV/AIDS, and infant and maternal mortality. VTHS was demonstrated to her Majesty the Queen on her recent visit and Elsevier have subsequently made enquiries

Stimulus-evoked high frequency oscillations are present in neuronal networks on microelectrode arrays

Pathological high frequency oscillations (250–600 Hz) are present in the brains of epileptic animals and humans. The etiology of these oscillations and how they contribute to the diseased state remains unclear. This work identifies the presence of microstimulation-evoked high frequency oscillations (250–400 Hz) in dissociated neuronal networks cultured on microelectrode arrays (MEAs). Oscillations are more apparent with higher stimulus voltages. As with in vivo studies, activity is isolated to a single electrode, however, the MEA provides improved spatial resolution with no spread of the oscillation to adjacent electrodes 200 μm away. Oscillations develop across four weeks in vitro. Oscillations still occur in the presence of tetrodotoxin and synaptic blockers, and they cause no apparent disruption in the ability of oscillation-presenting electrodes to elicit directly evoked action potentials (dAPs) or promote the spread of synaptic activity throughout the culture. Chelating calcium with ethylene glycol tetraacetic acid (EGTA) causes a temporal prolongation of the oscillation. Finally, carbenoxolone significantly reduces or eliminates the high frequency oscillations. Gap junctions may play a significant role in maintaining the oscillation given the inhibitory effect of carbenoxolone, the propagating effect of reduced calcium conditions and the isolated nature of the activity as demonstrated in previous studies. This is the first demonstration of stimulus-evoked high frequency oscillations in dissociated cultures. Unlike current models that rely on complex in vivo recording conditions, this work presents a simple controllable model in neuronal cultures on MEAs to further investigate how the oscillations occur at the molecular level and how they may contribute to the pathophysiology of disease

The ALMA Early Science View of FUor/EXor objects. IV. Misaligned Outflows in the Complex Star-forming Environment of V1647 Ori and McNeil's Nebula

We present Atacama Large Millimeter/sub-millimeter Array (ALMA) observations of the star-forming environment surrounding V1647 Ori, an outbursting FUor/EXor pre-MS star. Dust continuum and the (J = 2 - 1) $^{12}$CO, $^{13}$CO, C$^{18}$O molecular emission lines were observed to characterize the V1647 Ori circumstellar disc and any large scale molecular features present. We detect continuum emission from the circumstellar disc and determine a radius r = 40 au, inclination i = 17$^{\circ}$$^{+6}_{-9}$ and total disc mass of M$_{\mathrm{disk}}$ of ~0.1 M$_{\odot}$. We do not identify any disc structures associated with nearby companions, massive planets or fragmentation. The molecular cloud environment surrounding V1647 Ori is both structured and complex. We confirm the presence of an excavated cavity north of V1647 Ori and have identified dense material at the base of the optical reflection nebula (McNeil's Nebula) that is actively shaping its surrounding environment. Two distinct outflows have been detected with dynamical ages of ~11,700 and 17,200 years. These outflows are misaligned suggesting disc precession over ~5500 years as a result of anisotropic accretion events is responsible. The collimated outflows exhibit velocities of ~2 km s$^{-1}$, similar in velocity to that of other FUor objects presented in this series but significantly slower than previous observations and model predictions. The V1647 Ori system is seemingly connected by an "arm" of material to a large unresolved structure located ~20$"$ to the west. The complex environment surrounding V1647 Ori suggests it is in the early stages of star formation which may relate to its classification as both an FUor and EXor type object.Comment: 18 pages, 14 figures, 4 tables; accepted for publication in MNRA

The ALMA Early Science View of FUor/EXor Objects - V. Continuum Disc Masses and Sizes

Low-mass stars build a significant fraction of their total mass during short outbursts of enhanced accretion known as FUor and EXor outbursts. FUor objects are characterized by a sudden brightening of ∼5 mag at visible wavelengths within 1 yr and remain bright for decades. EXor objects have lower amplitude outbursts on shorter time-scales. Here we discuss a 1.3 mm Atacama Large Millimeter/submillimeter Array (ALMA) mini-survey of eight outbursting sources (three FUors, four EXors, and the borderline object V1647 Ori) in the Orion Molecular Cloud. While previous papers in this series discuss the remarkable molecular outflows observed in the three FUor objects and V1647 Ori, here we focus on the continuum data and the differences and similarities between the FUor and EXor populations. We find that FUor discs are significantly more massive (∼80–600 MJup) than the EXor objects (∼0.5–40 MJup). We also report that the EXor sources lack the prominent outflows seen in the FUor population. Even though our sample is small, the large differences in disc masses and outflow activity suggest that the two types of objects represent different evolutionary stages. The FUor sources seem to be rather compact (Rc \u3c 20–40 au) and to have a smaller characteristic radius for a given disc mass when compared to T Tauri stars. V1118 Ori, the only known close binary system in our sample, is shown to host a disc around each one of the stellar components. The disc around HBC 494 is asymmetric, hinting at a structure in the outer disc or the presence of a second disc

A Bayesian spatio-temporal framework to identify outbreaks and examine environmental and social risk factors for infectious diseases monitored by routine surveillance

Spatio-temporal disease patterns can provide clues to etiological pathways, but can be complex to model. Using a flexible Bayesian hierarchical framework, we identify previously undetected space-time clusters and environmental and socio-demographic risk factors for reported giardiasis and cryptosporidiosis at the New Zealand small area level. For giardiasis, there was no seasonal pattern in outbreak probability and an inverse association with density of dairy cattle (β^₁= -0.09, Incidence Risk Ratio (IRR) 0.90 (95% CI 0.84, 0.97) per 1 log increase in cattle/km²). In dairy farming areas, cryptosporidiosis outbreaks were observed in spring. Reported cryptosporidiosis was positively associated with dairy cattle density: β^₁= 0.12, IRR 1.13 (95% CI 1.05, 1.21) per 1 log increase in cattle/km2 and inversely associated with weekly average temperature: β^₁=-0.07, IRR 0.92 (95% CI 0.87, 0.98) per 4°C increase. This framework can be generalized to determine the potential drivers of sporadic cases and latent outbreaks of infectious diseases of public health importance

Empathy among undergraduate medical students: A multi-centre cross-sectional comparison of students beginning and approaching the end of their course

Abstract Background Although a core element in patient care the trajectory of empathy during undergraduate medical education remains unclear. Empathy is generally regarded as comprising an affective capacity: the ability to be sensitive to and concerned for, another and a cognitive capacity: the ability to understand and appreciate the other person’s perspective. The authors investigated whether final year undergraduate students recorded lower levels of empathy than their first year counterparts, and whether male and female students differed in this respect. Methods Between September 2013 and June 2014 an online questionnaire survey was administered to 15 UK, and 2 international medical schools. Participating schools provided both 5–6 year standard courses and 4 year accelerated graduate entry courses. The survey incorporated the Jefferson Scale of Empathy-Student Version (JSE-S) and Davis’s Interpersonal Reactivity Index (IRI), both widely used to measure medical student empathy. Participation was voluntary. Chi squared tests were used to test for differences in biographical characteristics of student groups. Multiple linear regression analyses, in which predictor variables were year of course (first/final); sex; type of course and broad socio-economic group were used to compare empathy scores. Results Five medical schools (4 in the UK, 1 in New Zealand) achieved average response rates of 55 % (n = 652) among students starting their course and 48 % (n = 487) among final year students. These schools formed the High Response Rate Group. The remaining 12 medical schools recorded lower response rates of 24.0 % and 15.2 % among first and final year students respectively. These schools formed the Lower Response Rate Group. For both male and female students in both groups of schools no significant differences in any empathy scores were found between students starting and approaching the end of their course. Gender was found to significantly predict empathy scores, with females scoring higher than males. Conclusions Participant male and female medical students approaching the end of their undergraduate education, did not record lower levels of empathy, compared to those at the beginning of their course. Questions remain concerning the trajectory of empathy after qualification and how best to support it through the pressures of starting out in medical practice