Duncan and the cholera test: public health in mid-nineteenth century Liverpool

Local studies have much to contribute to the study of the history of public health reform in nineteenth-century Britain. They may help elucidate the shifting margins between competition and complementarity in the efforts of local and national government. They can offer a corrective to hasty generalization from narrow, usually London-based, sources. They throw light upon the implementation of legislation and upon the local negotiation of the ideas and strategies of medical and political elites. It is equally important, however, that local studies remain aware of the national context of the issues being examined. Otherwise, the specific significance of the local study will be lost

Duncan and the cholera test: public health in mid-nineteenth century Liverpool

Local studies have much to contribute to the study of the history of public health reform in nineteenth-century Britain. They may help elucidate the shifting margins between competition and complementarity in the efforts of local and national government. They can offer a corrective to hasty generalization from narrow, usually London-based, sources. They throw light upon the implementation of legislation and upon the local negotiation of the ideas and strategies of medical and political elites. It is equally important, however, that local studies remain aware of the national context of the issues being examined. Otherwise, the specific significance of the local study will be lost

Spatiotemporal variation in harbor porpoise distribution and foraging across a landscape of fear

Funding information: Marine Alliance for Science and Technology for Scotland; Marine Scotland Science; University of AberdeenPeer reviewedPublisher PD

The role of laser interstitial thermal therapy in enhancing progression-free survival of difficult-to-access high-grade gliomas: A multicenter study

Surgical extent-of-resection has been shown to have an impact on high-grade glioma (HGG) outcomes; however, complete resection is rarely achievable in difficult-to-access (DTA) tumors. Controlled thermal damage to the tumor may have the same impact in DTA-HGGs. We report our multicenter results of laser interstitial thermal therapy (LITT) in DTA-HGGs. We retrospectively reviewed 34 consecutive DTA-HGG patients (24 glioblastoma, 10 anaplastic) who underwent LITT at Cleveland Clinic, Washington University, and Wake Forest University (May 2011–December 2012) using the NeuroBlate® System. The extent of thermal damage was determined using thermal damage threshold (TDT) lines: yellow TDT line (43°C for 2 min) and blue TDT line (43°C for 10 min). Volumetric analysis was performed to determine the extent-of-coverage of tumor volume by TDT lines. Patient outcomes were evaluated statistically. LITT was delivered as upfront in 19 and delivered as salvage in 16 cases. After 7.2 months of follow-up, 71% of cases demonstrated progression and 34% died. The median overall survival (OS) for the cohort was not reached; however, the 1-year estimate of OS was 68 ± 9%. Median progression-free survival (PFS) was 5.1 months. Thirteen cases who met the following two criteria—(1) <0.05 cm(3) tumor volume not covered by the yellow TDT line and (2) <1.5 cm(3) additional tumor volume not covered by the blue TDT line—had better PFS than the other 21 cases (9.7 vs. 4.6 months; P = 0.02). LITT can be used effectively for treatment of DTA-HGGs. More complete coverage of tumor by TDT lines improves PFS which can be translated as the extent of resection concept for surgery

Spatiotemporal variation in harbor porpoise distribution and foraging across a landscape of fear

Understanding spatiotemporally varying animal distributions can inform ecological understanding of species' behavior (e.g., foraging and predator/prey interactions) and support development of management and conservation measures. Data from an array of echolocation‐click detectors (C‐PODs) were analyzed using Bayesian spatiotemporal modeling to investigate spatial and temporal variation in occurrence and foraging activity of harbor porpoises (Phocoena phocoena) and how this variation was influenced by daylight and presence of bottlenose dolphins (Tursiops truncatus). The probability of occurrence of porpoises was highest on an offshore sandbank, where the proportion of detections with foraging clicks was relatively low. The porpoises' overall distribution shifted throughout the summer and autumn, likely influenced by seasonal prey availability. Probability of porpoise occurrence was lowest in areas close to the coast, where dolphin detections were highest and declined prior to dolphin detection, leading potentially to avoidance of spatiotemporal overlap between porpoises and dolphins. Increased understanding of porpoises' seasonal distribution, key foraging areas, and their relationship with competitors can shed light on management options and potential interactions with offshore industries

The Protective Action Encoding of Serotonin Transients in the Human Brain

The role of serotonin in human brain function remains elusive due, at least in part, to our inability to measure rapidly the local concentration of this neurotransmitter. We used fast-scan cyclic voltammetry to infer serotonergic signaling from the striatum of fourteen brains of human patients with Parkinson's disease. Here we report these novel measurements and show that they correlate with outcomes and decisions in a sequential investment game. We find that serotonergic concentrations transiently increase as a whole following negative reward prediction errors, while reversing when counterfactual losses predominate. This provides initial evidence that the serotonergic system acts as an opponent to dopamine signaling, as anticipated by theoretical models. Serotonin transients on one trial were also associated with actions on the next trial in a manner that correlated with decreased exposure to poor outcomes. Thus, the fluctuations observed for serotonin appear to correlate with the inhibition of over-reactions and promote persistence of ongoing strategies in the face of short-term environmental changes. Together these findings elucidate a role for serotonin in the striatum, suggesting it encodes a protective action strategy that mitigates risk and modulates choice selection particularly following negative environmental events

Student collaboration in developing an on-line self assessment tool to enhance development for student and newly qualified professionals

A “Competence in Practice” (CiPA) self assessment tool was developed initially as a research instrument as part of the Centre for Excellence in Teaching and Learning; Assessment and Learning in Practice Settings. The tool asks a series of questions against which participants self-rate their preparedness for practice. A working group then created software from this that is used as a formative exercise to rate confidence and perceived competence in practice. This freely available package (http://cipa.hud.ac.uk ) responds with feedback to individual users on their self evaluation, facilitating reflection and guided supervision. The development involved an innovative, collaborative partnership with academics and students, who undertook the work as a paid project as well as actively participating in workshops and conferences. Working collaboratively was a powerful experience for all involved. This paper presents the development of the tool as a case study focusing on the collaborative aspects of the work. Working collaboratively with students in this manner enabled many positive outcomes and lessons for the future

Competent to practice : evaluation of an electronic self assessment tool for student and graduate professionals

The Professional Statutory and Regulatory Bodies for health and social care professions identify competent practice at the point of qualification (or soon after) essential. This project aims to critically evaluate an electronic “Competence in Practice” self assessment tool developed initially an a research instrument as part of the Centre for Excellence in Teaching and Learning called Assessment and Learning in Practice Settings (http://www.alps-cetl.ac.uk/) The Competency in Practice Assessment tool (CiPA) asks a series of questions against which participants self-rate their preparedness for practice. The five universities and 16 health professions involved consulted extensively to ensure an acceptable tool was developed which was then calibrated and validated using RASCH analysis (Harrington et al 1997, Slade et al 2011). The second phase of its development created software that is used as a formative exercise to rate confidence and perceived competence in practice. The freely available package (http://cipa.hud.ac.uk/) responds with feedback to individual users on their self evaluation, facilitating reflection and guided supervision. An innovative partnership with 14 pre and post qualifying health and social care students and 2 computing students undertook the work as a paid project as well as actively participating in workshops and conferences. The third phase has been to seek ethical approval to evaluate the use of the tool; it is this work that we wish to present. In collaboration with two further computing students an online evaluation has been launched to explore its effectiveness. We are particularly interested in discovering the range of professions using CiPA, and the ways in which it is being utilised. Digital competence is essential for health professionals; in the UK much ongoing professional development, as well as standard induction is now on-line, facilitating ease of access and reducing time away from essential services for practitioners. However, the effectiveness of these resources is diminished if practitioners either do not, or cannot use them. The CiPA tool is a simple, self evaluation and feedback tool that can be used individually or with a mentor/ supervisor. This use of the tool not only may benefit individual people, but may also facilitate further on line self development. Through promoting lifelong learning and Continuing Professional Development CiPA can provide valuable support for pre qualifying and graduate professionals. It is therefore particularly pertinent to identify digitally enabled processes that can be developed in prequalifying education that facilitate transition into practice. There are many ‘self help’ tools so disseminating and promoting CiPA is a challenge. In addition choosing to have a widely applicable tool has advantages, but may lose some of the specificity that a tool designed for a single profession might have. This evaluation is an attempt to better understand these difficulties. An unquestionable strength has been the continued involvement of students in the design, delivery, promotion and evaluation of this work. The strategy, and lessons learned from this partnership are of relevance beyond this project