Response to Kamath et al 'A syncretic approach can yield dividends'

We welcome the response from Kamath et al. and their insight into the issues and culture within medicine in India, and their thoughts about how to address these issues. We also agree that a drama-based approach is not sufficient on its own to deal with entrenched power issues which affect students adversely. As we have indicated, we believe “a multipronged approach is needed to generate systemic change.” These authors similarly advocate that student mistreatment be dealt with “in a comprehensive manner” including a ‘grievance redressal system’ and other measures to withhold accreditation where there are issues of abuse of power. Nevertheless, we note that Kamath et al. have responded positively to our approach—as a part of that mix—and it would be of great interest to see whether drama-based workshops could support medical students developing embodied acting skills in their institution and whether they may have similar transformative effects. We’d like to refer the authors to an excellent Medical Humanities paper we referenced that outlined drama-based activities in medical education in India: Gupta S, Singh S. Confluence: understanding medical humanities through street theatre. Medical Humanities. 2011;37(2):127-128. Despite the above article, the authors note that medical education in India has not embraced the medical humanities. We would draw a distinction within the medical humanities between activities which are primarily studious (reading literature, studying medical history) and workshops that are based on participative and embodied activity. Our experience has indicated the effectiveness of drama-based workshops in addressing both the cognitive and emotive aspects of harmful practices and we believe that it is the embodied nature of acting skills workshops that is transformative

Occupational allergy to fruit flies (Drosophila melanogaster) in laboratory workers

OBJECTIVES: Drosophila melanogaster (the 'fruit fly') is commonly used in genetic research, but there is only one report of IgE-associated allergy in exposed workers. 4 newly identified cases prompted us to examine the extent of this problem in a university laboratory. Our aim in this study is to determine the prevalence and determinants of sensitisation to fruit flies in a population of exposed workers. METHODS: In a cross-sectional study, we surveyed 286 employees working in a department carrying out research involving D. melanogaster. Sensitisation was assessed by specific IgE measurement in serum and examined in relation to symptoms and to estimated exposure to fruit flies. RESULTS: The overall prevalence of specific sensitisation was 6% with a clear relationship to increasing frequency/intensity of exposure (p trend<0.001). Work-related eye/nose, chest or skin symptoms were reported by substantial proportions of participants but for most of these there was no evidence of specific sensitisation to fruit fly. The overall prevalence of any work-related symptoms and sensitisation was 2.4%, rising to 7.1% in those working in high exposure groups. CONCLUSIONS: We were able to demonstrate, for the first time, a clear exposure-response relationship between fruit fly exposure and specific sensitisation. Facilities housing fruit flies should carefully consider methods to reduce exposure levels in the workplace

In reply to: Questioning the ethics of ethicists

Hamor questions ‘the ethics of the ethicists’ without addressing the substantive points made in our paper.1 While our empirical findings were that physicians and members of the public consider that some gifts are appropriate, we go further and explore the implications of those findings.2 Just as a public survey finding support for capital punishment would not be sufficient to convince us that it was right, we argue that pharmaceutical industry largesse should not be accepted simply because it enjoys popular or professional support. Data are important, but are not the only consideration. Values, including the independence of clinical decision making and the primacy of patient welfare, should also be considered. These are accepted ethical commitments within the profession. For these reasons, we question pharmaceutical marketing and the use of ‘gifts’ to influence doctors' prescribing. There is concern in the literature about the potential for this strategy to bias doctors' judgments. The giving of ‘gifts’ to doctors has the intended outcome that doctors prescribe from loyalty to the ‘gift’ giver rather than prescribing on the basis of evidence of drug efficacy and safety. Even a small gift like ‘post-it’ notes can have this effect. Hamor, however, appears to argue that acceptance of gifts from industry is not morally problematic without addressing the primary concern that this may undermine the independence of clinical decision making and potentially put patients at risk

Influence of accountants\u27 certificates on commercial credit

https://egrove.olemiss.edu/aicpa_att/1076/thumbnail.jp

Comparison of lotions, creams, gels and ointments for the treatment of childhood eczema: The BEE RCT

BackgroundEmollients are recommended for children with eczema (atopic eczema/dermatitis). A lack of head-to-head comparisons of the effectiveness and acceptability of the different types of emollients has resulted in a ‘trial and error’ approach to prescribing.ObjectiveTo compare the effectiveness and acceptability of four commonly used types of emollients for the treatment of childhood eczema.DesignFour group, parallel, individually randomised, superiority randomised clinical trials with a nested qualitative study, completed in 2021. A purposeful sample of parents/children was interviewed at ≈ 4 and ≈ 16 weeks.SettingPrimary care (78 general practitioner surgeries) in England.ParticipantsChildren aged between 6 months and 12 years with eczema, of at least mild severity, and with no known sensitivity to the study emollients or their constituents.InterventionsStudy emollients sharing the same characteristics in the four types of lotion, cream, gel or ointment, alongside usual care, and allocated using a web-based randomisation system. Participants were unmasked and the researcher assessing the Eczema Area Severity Index scores was masked.Main outcome measuresThe primary outcome was Patient-Oriented Eczema Measure scores over 16 weeks. The secondary outcomes were Patient-Oriented Eczema Measure scores over 52 weeks, Eczema Area Severity Index score at 16 weeks, quality of life (Atopic Dermatitis Quality of Life, Child Health Utility-9 Dimensions and EuroQol-5 Dimensions, five-level version, scores), Dermatitis Family Impact and satisfaction levels at 16 weeks.ResultsA total of 550 children were randomised to receive lotion (analysed for primary outcome 131/allocated 137), cream (137/140), gel (130/135) or ointment (126/138). At baseline, 86.0% of participants were white and 46.4% were female. The median (interquartile range) age was 4 (2–8) years and the median Patient-Oriented Eczema Measure score was 9.3 (SD 5.5). There was no evidence of a difference in mean Patient-Oriented Eczema Measure scores over the first 16 weeks between emollient types (global p = 0.765): adjusted Patient-Oriented Eczema Measure pairwise differences – cream–lotion 0.42 (95% confidence interval –0.48 to 1.32), gel–lotion 0.17 (95% confidence interval –0.75 to 1.09), ointment–lotion –0.01 (95% confidence interval –0.93 to 0.91), gel–cream –0.25 (95% confidence interval –1.15 to 0.65), ointment–cream –0.43 (95% confidence interval –1.34 to 0.48) and ointment–gel –0.18 (95% confidence interval –1.11 to 0.75). There was no effect modification by parent expectation, age, disease severity or the application of UK diagnostic criteria, and no differences between groups in any of the secondary outcomes. Median weekly use of allocated emollient, non-allocated emollient and topical corticosteroids was similar across groups. Overall satisfaction was highest for lotions and gels. There was no difference in the number of adverse reactions and there were no significant adverse events. In the nested qualitative study (n = 44 parents, n = 25 children), opinions about the acceptability of creams and ointments varied most, yet problems with all types were reported. Effectiveness may be favoured over acceptability. Parents preferred pumps and bottles over tubs and reported improved knowledge about, and use of, emollients as a result of taking part in the trial.LimitationsParents and clinicians were unmasked to allocation. The findings may not apply to non-study emollients of the same type or to children from more ethnically diverse backgrounds.ConclusionsThe four emollient types were equally effective. Satisfaction with the same emollient types varies, with different parents/children favouring different ones. Users need to be able to choose from a range of emollient types to find one that suits them.Future workFuture work could focus on how best to support shared decision-making of different emollient types and evaluations of other paraffin-based, non-paraffin and ‘novel’ emollients.Trial registrationThis trial is registered as ISRCTN84540529 and EudraCT 2017-000688-34.FundingThis project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (HTA 15/130/07) and will be published in full in Health Technology Assessment; Vol. 27, No. 19. See the NIHR Journals Library website for further project information

Switching magnetization with a Weyl semimetal

Energy-efficient magnetization manipulation is a prerequisite for competitive spintronic devices. The Weyl semimetal WTe2 can act as a spin current source that enables magnetization switching of an adjacent ferromagnet at low power consumption and additionally induces chiral magnetism.</p

Physical activity and psychosocial characteristics of the peer supporters in the PLAN-A study – a latent class analysis

PLAN-A is a cluster randomised controlled trial of a peer-led physical activity intervention which uses peer supporters to increase the physical activity of 13–14-year-old girls in the UK. This paper uses latent class analysis to identify classes in the whole study population and investigate how those selected as peer supporters in PLAN-A were drawn from different social groups. We identified five classes of girls, based on psychosocial variables (self-esteem, physical activity self-efficacy, motivation, physical activity values among friends and peer support for physical activity (PA) and physical activity behaviour variables (average minutes of weekday MVPA, sedentary time and screen viewing). Peer supporters were similar to the whole study population in terms of overall demographics, but were drawn unequally from the five classes. In addition, there was considerable variation in the distribution of peer supporters between schools. The selection of peer supporters is an integral component of peer-led interventions and should be explored and linked to underlying theory to understand the characteristics of those recruited. However, demographic representativeness is not necessarily the aim, and simple reporting of overall demographic comparisons may mask important differences within subgroups