Evidence-based medicine and values-based medicine : partners in clinical education as well as in clinical practice

The best clinical decisions are based on both evidence and values in what is known as the ‘twofeet principle’. Anecdotally, educationalists find teaching clinicians to become more evidence based is relatively simple in comparison to encouraging them to become more values based. One reason is likely to be the importance of values awareness. As valuesbased practice is premised on a mutual respect for the diversity of values, clinicians need to develop the skills to ascertain patient values and to get in touch with their own beliefs and preferences in order to understand those at play in any consultation. Only then can shared decision-making processes take place within a shared framework of values. In a research article published in BMC Medicine, AltamiranoBustamante and colleagues highlight difficulties that clinicians face in getting in touch with their own values. Despite finding that healthcare personnel’s core values were honesty and respect, autonomy was initially low ranked by participants. One significant aspect of this work is that this group has demonstrated that the extent to which clinicians value ‘autonomy’ and ‘openness to change’ can both be positively influenced by well designed education

Roman diet and trade: evidence from organic residues on pottery sherds recovered at the Roman town of Calleva Atrebatum (Silchester Hants.)

The analysis of organic residues from pottery sherds using Gas-Chromatography with mass-spectroscopy (GC-MS) has revealed information about the variety of foods eaten and domestic routine at Silchester between the second and fourth–sixth centuries A.D. Two results are discussed in detail: those of a second-century Gauloise-type amphora and a fourth-century SE Dorset black-burnished ware (BB1) cooking pot, which reveal the use of pine pitch on the inner surface of the amphora and the use of animal fats (ruminant adipose fats) and leafy vegetables in cooking at the Roman town of Silchester, Hants

Tear film thickness variations and the role of the tear meniscus

A mathematical model is developed to investigate the two-dimensional variations in the thickness of tear fluid deposited on the eye surface during a blink. Such variations can become greatly enhanced as the tears evaporate during the interblink period.\ud The four mechanisms considered are: i) the deposition of the tear film from the upper eyelid meniscus, ii) the flow of tear fluid from under the eyelid as it is retracted and from the lacrimal gland, iii) the flow of tear fluid around the eye within the meniscus and iv) the drainage of tear fluid into the canaliculi through the inferior and superior puncta.\ud There are two main insights from the modelling. First is that the amount of fluid within the tear meniscus is much greater than previously employed in models and this significantly changes the predicted distribution of tears. Secondly the uniformity of the tear film for a single blink is: i) primarily dictated by the storage in the meniscus, ii) quite sensitive to the speed of the blink and the ratio of the viscosity to the surface tension iii) less sensitive to the precise puncta behaviour, the flow under the eyelids or the specific distribution of fluid along the meniscus at the start of the blink. The modelling briefly examines the flow into the puncta which interact strongly with the meniscus and acts to control the meniscus volume. In addition it considers flow from the lacrimal glands which appears to occurs continue even during the interblink period when the eyelids are stationary

Determination of the Potential Impact of Domestic Anaerobic Digester Systems: A Community Based Research Initiative in Rural Bangladesh

This research examines the potential impact of domestic anaerobic digester (AD) systems adopted in Bangladesh and similar developing countries. Cattle dung and poultry litter feed stocks were specifically investigated, because these were freely available and plentiful to people living within agricultural areas of rural Bangladesh. Data was collected to ascertain whether these two representative AD facility types provide tangible social, economic and environmental impact that benefits homeowners. Primary quantitative and qualitative data was obtained by field data collection, and meeting with expert groups and stakeholders. Empirical analysis conducted revealed that variations were found in the biomass feedstocks available on different sites but also differences were apparent in terms of the operations and maintenance (O and M) systems of the biogas plants operated. The biogas and methane yield variation was also measured, and variations were found in the cattle dung and poultry litter AD yield capacity. Overall, 64% of feedstock was utilised, 91% of biogas plants remain underfed and energy yield efficiency was 57% from cattle smallholdings’ AD and 28% from poultry farms’ AD. These results showed that small scale AD can offer a significant impact upon rural lifestyles through augmented economics, improved social activities, relationship building with neighbours and improved lifestyle achieved via time savings accrued. These results could help rural entrepreneurs, AD equipment providers and government institutions to develop a road map to implement future AD installation on a much wider geographical scale

Street smart: faster approach towards litter in urban areas by highly neophobic corvids and less fearful birds.

The extent to which animals respond fearfully to novel stimuli may critically influence their ability to survive alongside humans. However, it is unclear whether the fear of novel objects, object neophobia, consistently varies in response to human disturbance. Where variation has been documented, it is unclear whether this variation is due to a change in fear towards specific novel stimuli, or whether it is symptomatic of a general change in fear behaviour. We measured levels of object neophobia in free-flying birds across urban and rural habitats, comparing corvids, a family known for being behaviourally flexible and innovative, with other urban-adapting bird species. Neophobic responses were measured in the presence of different types of objects that varied in their novelty, and were compared to behaviour during a baited control. Corvids were more neophobic than noncorvid species towards all object types, but their hesitancy abated after conspecifics approached in experimental conditions in which objects resembled items they may have experienced previously. Both sets of species were faster to approach objects made from human litter in urban than rural areas, potentially reflecting a category-specific reduction in fear based on experience. These results highlight species similarities in behavioural responses to human-dominated environments despite large differences in baseline neophobia.A.G. received generous support from the Gates-Cambridge Trust. A.T. was supported by a BBSRC David Phillips Fellowship (BB/H021817/1) and a grant from the British Ecological Society.This is the final version of the article. It first appeared from Elsevier via https://doi.org/10.1016/j.anbehav.2016.03.02

Evaluating Ecosystem Response to Oyster Restoration and Nutrient Load Reduction With a Multispecies Bioenergetics Model

Many of the world\u27s coastal ecosystems are impacted by multiple stressors each of which may be subject to different management strategies that may have overlapping or even conflicting objectives. Consequently, management results may be indirect and difficult to predict or observe. We developed a network simulation model intended specifically to examine ecosystem-level responses to management and applied this model to a comparison of nutrient load reduction and restoration of highly reduced stocks of bivalve suspension feeders (eastern oyster, Crassostrea virginica) in an estuarine ecosystem (Chesapeake Bay, USA). Model results suggest that a 50% reduction in nutrient inputs from the watershed will result in lower phytoplankton production in the spring and reduced delivery of organic material to the benthos that will limit spring and summer pelagic secondary production. The model predicts that low levels of oyster restoration will have no effect in the spring but does result in a reduction in phytoplankton standing stocks in the summer. Both actions have a negative effect on pelagic secondary production, but the predicted effect of oyster restoration is larger. The lower effect of oysters on phytoplankton is due to size-based differences infiltration efficiency and seasonality that result in maximum top-down grazer control of oysters at a time when the phytoplankton is already subject to heavy grazing. These results suggest that oyster restoration must be achieved at levels as much as 25-fold present biomass to have a meaningful effect on phytoplankton biomass and as much as 50-fold to achieve effects similar to a 50% nutrient load reduction. The unintended effect of oyster restoration at these levels on other consumers represents a trade-off to the desired effect of reversing eutrophication

Evaluating the Potential of Rice Straw as a Co-digestion Feedstock for Biogas Production in Bangladesh

This research was done to evaluate the potential energy yield capacity of rice straw for anaerobic digestion (AD) as an alternative use of this material. Cattle markets were found to be a potential source that generates a significant amount of a mixture of 80% straw + 20% cattle dung. This waste rice straw/dung mix from cattle markets provides a good mixture with a much better C/N ratio than pure straw. This mix of straw and dung are often left in piles in the market for between 10 and 20 days, where they degrade naturally. Tests involving feeding this mixture into a domestic biogas plant showed that the biogas yield is 0.099 m3/kg feed stock with a methane content of 74.43%. . In the whole of Bangladesh there are 500 cattle markets, so their waste can produce about 35,000,000 MJ of energy through AD. A biogas plant will continue to generate biogas, even after daily feeding has been stopped, although the gas production and the methane content do reduce with time

Why the idea of framework propositions cannot contribute to an understanding of delusions

One of the tasks that recent philosophy of psychiatry has taken upon itself is to extend the range of understanding to some of those aspects of psychopathology that Jaspers deemed beyond its limits. Given the fundamental difficulties of offering a literal interpretation of the contents of primary delusions, a number of alternative strategies have been put forward including regarding them as abnormal versions of framework propositions described by Wittgenstein in On Certainty. But although framework propositions share some of the apparent epistemic features of primary delusions, their role in partially constituting the sense of inquiry rules out their role in helping to understand delusions

Enhanced task-related brain activation and resting perfusion in healthy older adults after chronic blueberry supplementation

© 2017, Canadian Science Publishing. All rights reserved. Blueberries are rich in flavonoids, which possess antioxidant and anti-inflammatory properties. High flavonoid intakes attenuate age-related cognitive decline, but data from human intervention studies are sparse. We investigated whether 12 weeks of blueberry concentrate supplementation improved brain perfusion, task-related activation, and cognitive function in healthy older adults. Participants were randomised to consume either 30 mL blueberry concentrate providing 387 mg anthocyanidins (5 female, 7 male; age 67.5 ± 3.0 y; body mass index, 25.9 ± 3.3 kg·m−2) or isoenergetic placebo (8 female, 6 male; age 69.0 ± 3.3 y; body mass index, 27.1 ± 4.0 kg·m−2). Pre-and postsupplementation, participants undertook a battery of cognitive function tests and a numerical Stroop test within a 1.5T magnetic resonance imaging scanner while functional magnetic resonance images were continuously acquired. Quantitative resting brain perfusion was determined using an arterial spin labelling technique, and blood biomarkers of inflammation and oxidative stress were measured. Significant increases in brain activity were observed in response to blueberry supplementation relative to the placebo group within Brodmann areas 4/6/10/ 21/40/44/45, precuneus, anterior cingulate, and insula/thalamus (p < 0.001) as well as significant improvements in grey matter perfusion in the parietal (5.0 ± 1.8 vs-2.9 ± 2.4%, p = 0.013) and occipital (8.0 ± 2.6 vs-0.7 ± 3.2%, p = 0.031) lobes. There was also evidence suggesting improvement in working memory (2-back test) after blueberry versus placebo supplementation (p = 0.05). Supplementation with an anthocyanin-rich blueberry concentrate improved brain perfusion and activation in brain areas associated with cognitive function in healthy older adults

Prevalence of rickets-like bone deformities in rural Gambian children.

The aim of this study was to estimate the burden of childhood rickets-like bone deformity in a rural region of West Africa where rickets has been reported in association with a low calcium intake. A population-based survey of children aged 0.5-17.9 years living in the province of West Kiang, The Gambia was conducted in 2007. 6221 children, 92% of those recorded in a recent census, were screened for physical signs of rickets by a trained survey team with clinical referral of suspected cases. Several objective measures were tested as potential screening tools. The prevalence of bone deformity in children <18.0 years was 3.3%. The prevalence was greater in males (M = 4.3%, F = 2.3%, p < 0.001) and in children <5.0 years (5.7%, M = 8.3%, F = 2.9%). Knock-knee was more common (58%) than bow-leg (31%) or windswept deformity (9%). Of the 196 examined clinically, 36 were confirmed to have a deformity outside normal variation (47% knock-knee, 53% bow-leg), resulting in more conservative prevalence estimates of bone deformity: 0.6% for children <18.0 years (M = 0.9%, F = 0.2%), 1.5% for children < 5.0 years (M = 2.3%, F = 0.6%). Three of these children (9% of those with clinically-confirmed deformity, 0.05% of those screened) had active rickets on X-ray at the time of medical examination. This emphasises the difficulties in comparing prevalence estimates of rickets-like bone deformities from population surveys and clinic-based studies. Interpopliteal distance showed promise as an objective screening measure for bow-leg deformity. In conclusion, this population survey in a rural region of West Africa with a low calcium diet has demonstrated a significant burden of rickets-like bone deformity, whether based on physical signs under survey conditions or after clinical examination, especially in boys < 5.0 years