Evaluating professionalism, teamwork and leadership in medical undergraduates

The complexity of healthcare is increasing due to new discoveries in the treatment of disease, the multiple pathologies of an ageing population and changes in working patterns and job roles. In addition, an increase in professional, regulatory and public scrutiny has led to revelations of poor care leading to preventable disability and death. Inquiries into sub-standard care have uncovered a number of professional lapses, in particular failures in teamwork and leadership. Medical undergraduates are future doctors. Their ability to work effectively within teams and to lead when necessary will therefore have a significant impact on the health of the population. In order to improve leadership and teamwork abilities we must be able to assess them. A literature review searching for a tool to assess teamwork and leadership in the medical undergraduate was carried out. As a consequence of an unsuccessful search, a tool was developed and evaluated, using data from existing tools and from a series of focus groups with medical undergraduates. The focus groups and an examination of the reasoning of assessment participants also informed a study on the justifications for failing to challenge poor performance by a more senior member of staff. The tool data showed adequate validity and reliability for formative assessments in a simulated environment. The focus groups and examination of reasoning highlighted the continued existence of the medical hierarchy, with steep authority gradients. This tool can be used in formative assessments, but further research is required before it is used outside the simulated environment and consideration must be given to psychometrics, feasibility and cost. The teaching and assessment of teamwork and leadership, should be given more time in the undergraduate curriculum and medical schools, regulatory bodies, deaneries and trusts should collaborate on minimising the unprofessional behaviours of senior healthcare personnel

Simulation in the time of COVID 19

© 2020 The Author(s). This an open access work distributed under the terms of the Creative Commons Attribution Licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.The Corona virus disease 2019 (COVID-19), FFP3 (filtering face piece-3), COVID, shielding, powered air-purifying respirator (PAPR), donning, doffing... are aA plethora of words and acronyms little known to the simulation community which have been added to our lexicon. A year ago the pre-conference editorial referred to the challenges of an ageing population, complex treatments, limited resources, and out of hospital care. To those we must now add a pandemic which continues to have a colossal impact on society. The world has momentarily been paralysed in order to find strategies to minimise and control the spread of the virus. The economy of every country has suffered as our way of living, working, travelling, and doing business changed. The aims were to minimise the loss of life and not overwhelm the healthcare system. While many “routine” simulation sessions have decreased or even ceased, simulation- based education (SBE) which is directly relevant to dealing with the particulars of an infectious agent has greatly increased. In one of the author’s own hospital, simulation was used to prepare healthcare staff for doffing and donning personal protective equipment (PPE), proning ventilated patients, optimising patient pathways and much more. The pandemic has, in many ways, forced the simulation community to put its money where its mouth is. Years of extolling the benefits of simulation in terms of upskilling, rapid cycle learning and resilience was now put to the test. Even people who were slightly skeptical about SBE became advocates of “trying things out in a safe environment” and encouraged the delivery of training sessions during which clinicians could practise to ensure their own safety and that of their colleagues.Peer reviewe

FMRFamide-Like Peptides (FLPs) Enhance Voltage-Gated Calcium Currents to Elicit Muscle Contraction in the Human Parasite Schistosoma mansoni

Schistosomes are amongst the most important and neglected pathogens in the world, and schistosomiasis control relies almost exclusively on a single drug. The neuromuscular system of schistosomes is fertile ground for therapeutic intervention, yet the details of physiological events involved in neuromuscular function remain largely unknown. Short amidated neuropeptides, FMRFamide-like peptides (FLPs), are distributed abundantly throughout the nervous system of every flatworm examined and they produce potent myoexcitation. Our goal here was to determine the mechanism by which FLPs elicit contractions of schistosome muscle fibers. Contraction studies showed that the FLP Tyr-Ile-Arg-Phe-amide (YIRFamide) contracts the muscle fibers through a mechanism that requires Ca2+ influx through sarcolemmal voltage operated Ca2+ channels (VOCCs), as the contractions are inhibited by classical VOCC blockers nicardipine, verapamil and methoxyverapamil. Whole-cell patch-clamp experiments revealed that inward currents through VOCCs are significantly and reversibly enhanced by the application of 1 µM YIRFamide; the sustained inward currents were increased to 190% of controls and the peak currents were increased to 180%. In order to examine the biochemical link between the FLP receptor and the VOCCs, PKC inhibitors calphostin C, RO 31–8220 and chelerythrine were tested and all produced concentration dependent block of the contractions elicited by 1 µM YIRFamide. Taken together, the data show that FLPs elicit contractions by enhancing Ca2+ influx through VOCC currents using a PKC-dependent pathway

Infiltrative and drug-resistant slow-cycling cells support metabolic heterogeneity in glioblastoma

Metabolic reprogramming has been described in rapidly growing tumors, which are thought to mostly contain fast‐cycling cells (FCCs) that have impaired mitochondrial function and rely on aerobic glycolysis. Here, we characterize the metabolic landscape of glioblastoma (GBM) and explore metabolic specificities as targetable vulnerabilities. Our studies highlight the metabolic heterogeneity in GBM, in which FCCs harness aerobic glycolysis, and slow‐cycling cells (SCCs) preferentially utilize mitochondrial oxidative phosphorylation for their functions. SCCs display enhanced invasion and chemoresistance, suggesting their important role in tumor recurrence. SCCs also demonstrate increased lipid contents that are specifically metabolized under glucose‐deprived conditions. Fatty acid transport in SCCs is targetable by pharmacological inhibition or genomic deletion of FABP7, both of which sensitize SCCs to metabolic stress. Furthermore, FABP7 inhibition, whether alone or in combination with glycolysis inhibition, leads to overall increased survival. Our studies reveal the existence of GBM cell subpopulations with distinct metabolic requirements and suggest that FABP7 is central to lipid metabolism in SCCs and that targeting FABP7‐related metabolic pathways is a viable therapeutic strategy

The CI-FLOW Project: A System for Total Water Level Prediction from the Summit to the Sea

Kildow et al. (2009) reported that coastal states support 81% of the U.S. population and generate 83 percent [$11.4 trillion (U.S. dollars) in 2007] of U.S. gross domestic product. Population trends show that a majority of coastal communities have transitioned from a seasonal, predominantly weekend, tourist-based economy to a year-round, permanently based, business economy where industry expands along shorelines and the workforce commutes from inland locations. As a result of this transition, costs associated with damage to the civil infrastructure and disruptions to local and regional economies due to coastal flooding events are escalating, pushing requirements for a new generation of flood prediction technologies and hydrologic decision support tools

Situation Awareness and Decision Making

Presentation on Situation Awareness and Decision Making, part of Human Factors module, Scottish Ambulance Academy, GCU School of Health and Life Science

Schistosome I/Lamides - A new family of bioactive helminth neuropeptides

Here we report the identification of a new family of helminth neuropeptides with members in both nematodes and flatworms, and include preliminary cell biological and functional characterisation of one of the peptides from the trematode parasite of humans,Schistosoma mansoni. Bioinformatics and Rapid Amplification of cDNA Ends (RACE)-PCR were used to identify the complete S. mansoni neuropeptide precursor gene Sm-npp-1, which encodes three pentapeptides bearing the motif (A/G)FVR(I/L).NH2. Similar peptides were identified in three other flatworm species and in 15 nematode species. Quantitative PCR (qPCR) and immunocytochemical (ICC) analyses showed that Sm-npp-1 is constitutively expressed in larval and adult worms. ICC and confocal microscopy were employed to localise one of the schistosome NPP-1 peptides (GFVRIamide) in adult worms and schistosomules; antibodies labelled a pair of neurones in the cerebral ganglia that extend posteriorly along the main nerve cords. GFVRIamide displayed no detectable co-localisation with FMRFamide-like peptides (FLPs), nor was it detectable in muscle innervation. Exogenously applied peptide had a significant inhibitory effect on the mobility of whole adult worm pairs at 10−5 M (n = 9). Finally, we explored Sm-npp-1function in schistosomules using RNA interference (RNAi); we successfully achieved specific knockdown of the Sm-npp-1 transcript (54.46 ± 10.41% knockdown, n = 3), but did not detect any clear, aberrant mobility or morphological phenotypes. NPP-1-like peptides are a new family of helminth peptides with a cell-specific expression pattern distinct from FLPs and a modulatory effect on schistosome muscular activity

POLITICAL ECONOMY AND PEEL'S REPEAL OF THE CORN LAWS

The repeal of the Corn Laws in Britain in 1846 has been much debated as to whether interest groups or ideology contributed most to this policy reform. This paper examines a conventional view that Sir Robert Peel, in proposing repeal, converted from protection to free trade under the influence of the ideas of political economy. It is shown that economic ideas had a crucial influence on Peel, but that he remained skeptical of political economy as a doctrine. Copyright 1989 Blackwell Publishers Ltd..