Community-engaged primary care medical education

BACKGROUND: Community-engaged medical education (CEME) requires medical schools to partner with local communities to help address community priorities, whilst enhancing the learning experiences of students. Current literature on CEME has focused on evaluating its effects on students; however, there remains a gap in exploring whether CEME initiatives can have a sustainable impact for communities. APPROACH: The Community Action Project (CAP) at Imperial College London, is an eight-week, community-engaged, quality improvement project for Year 3 medical students. Students initially consult with clinicians, patients and wider community stakeholders to understand local needs and assets, and identify a health priority to address. They then work with relevant stakeholders to design, implement and evaluate a project to help address their identified priority. EVALUATION: All CAPs (n = 264) completed in the 2019-2021 academic years were evaluated for evidence of several key areas, including community engagement and sustainability. 91% of projects evidenced a needs analysis, 71% demonstrated patient involvement in their development, and 64% demonstrated sustainable impacts from their projects. Analysis revealed the topics frequently addressed, and the formats used by students. Two CAPs are described in more detail to demonstrate their community impact. IMPLICATIONS: The CAP demonstrates how the principles of CEME (meaningful community engagement and social accountability) can lead to sustainable benefits for local communities through purposeful collaboration with patients and local communities. Strengths, limitations and future directions are highlighted

Dependence of Deodorant Usage on ABCC11 Genotype:Scope for Personalized Genetics in Personal Hygiene

Earwax type and axillary odor are genetically determined by rs17822931, a single-nucleotide polymorphism (SNP) located in the ABCC11 gene. The literature has been concerned with the Mendelian trait of earwax, although axillary odor is also Mendelian. Ethnic diversity in rs17822931 exists, with higher frequency of allele A in east Asians. Influence on deodorant usage has not been investigated. In this work, we present a detailed analysis of the rs17822931 effect on deodorant usage in a large (N∼17,000 individuals) population cohort (the Avon Longitudinal Study of Parents and Children (ALSPAC)). We found strong evidence (P=3.7 × 10(−20)) indicating differential deodorant usage according to the rs17822931 genotype. AA homozygotes were almost 5-fold overrepresented in categories of never using deodorant or using it infrequently. However, 77.8% of white European genotypically nonodorous individuals still used deodorant, and 4.7% genotypically odorous individuals did not. We provide evidence of a behavioral effect associated with rs17822931. This effect has a biological basis that can result in a change in the family's environment if an aerosol deodorant is used. It also indicates potential cost saving to the nonodorous and scope for personalized genetics usage in personal hygiene choices, with consequent reduction of inappropriate chemical exposures for some

Patient Perceptions of Effectiveness in Treatments for Menière's Disease: a National Survey in Italy

Objective: The aim of this study was to investigate current treatment practices and self-reported effectiveness in Menière's disease. Materials and Methods: Members of two Italian Menière's disease support (n=170) with ≥6-month history of Menière's disease were administered an online survey about recent treatments. Vertigo episode count, work absenteeism, and limitations in family life, social life,work or travel, as included in the Social Life and Work Impact of Dizziness (SWID) Questionnaire before and after recent treatments were queried. Results: Twenty-four different treatments were reported for Menière's disease, with dietary modifications (55%), diuretics (47%), and betahistine (41%) being most common. The majority (71%) received multiple simultaneous treatments. Prior to the most recent treatments 78-89% of respondents indicated limitations in family or social life, work or traveling. After their most recent treatment, respondents reported improvements in mean vertigo episode counts (5.7±7.6 vs. 2.6 ±4.6, p<0.001), days off work per month (10.1 ±9.2 vs. 4.2 ±6.7, p<0.001), and proportions indicating limitations in any functional measure assessed (p<0.05). These findings were consistent regardless of treatment approach (all p<0.05). Intratympanic gentamicin provided the greatest reductions in vertigo count, functional limitations, and work absenteeism (all p<0.01) as well as the fewest respondents reporting post-treatment functional limitations (16-37%). Conclusions: Despite numerous treatment approaches targeting different proposed pathophysiology for Menière's disease in this cross-sectional survey, all treatments are reported as effective by patients. These findings support a prominent placebo effect in Menière's disease and highlight challenges in studying treatment outcomes; there is a critical need to better understand Menière's disease

Community action projects: community-engaged quality improvement for medical students.

BACKGROUND: Healthcare Quality Improvement (QI) is an essential skill for medical students to acquire, although there is insufficient empirical research which suggests the best educational methods to do this. This study explored the experiences of medical students participating in two versions of a Community Action Project (CAP) which gave medical students the opportunity to learn QI skills in a community setting. The first version (GPCAP) was pre-pandemic where students identified and delivered QI projects on placement in general practice to improve local population health. The second version (Digi-CAP) ran remotely where students worked on QI projects identified by local voluntary sector organisations focused on local community priorities during COVID-19. METHODS: Semi-structured interviews were conducted with volunteers from the two cohorts of students who had taken part in quality improvement initiatives. Transcriptions were independently coded by two researchers and analysed through thematic analysis. RESULTS: Sixteen students were interviewed. Whilst students had mixed experiences of completing their CAP, engagement and successful learning was associated with the following themes from the two versions of QI CAP projects: finding a sense of purpose and meaning in QI projects; preparedness for responsibility and service-driven learning; the importance of having supportive partnerships throughout the project duration and making a sustainable difference. CONCLUSIONS AND IMPLICATIONS: The study provides valuable insights into the design and implementation of these community-based QI projects, which enabled students to learn new and often hard to teach skills, whilst working on projects which have a sustainable impact on local community outcomes

Crystallisation-induced emission enhancement in Zn(II) Schiff base complexes with a tuneable emission colour

Four Zn(II) Schiff base complexes that exhibit crystallisation-induced emission enhancement (CIEE) are presented. There is an intermolecular dimerisation through the hydrogen bonding of the mixed phenol/phenolate donors. The choice of ligand also determines the emission wavelength. The complexes have been investigated using experimental and theoretical techniques

Approccio alla lingua italiana per allievi stranieri - ALIAS

Contiene, di P. E. Balboni, - "Approccio alla lingua italiana per allievi stranieri", pp. 55-71 - "Problemi interculturali nei rapporti con allievi stranieri e con le loro famiglie", pp. 73-90 - "La fomrazione dei docenti: i contenuti e gli strumenti di base", pp. 181-184

Glycinergic Axonal Inhibition Subserves Acute Spatial Sensitivity To Sudden Increases In Sound Intensity

Locomotion generates adventitious sounds which enable detection and localization of predators and prey. Such sounds contain brisk changes or transients in amplitude. We investigated the hypothesis that ill-understood temporal specializations in binaural circuits subserve lateralization of such sound transients, based on different time of arrival at the ears (interaural time differences, ITDs). We find that Lateral Superior Olive (LSO) neurons show exquisite ITD-sensitivity, reflecting extreme precision and reliability of excitatory and inhibitory postsynaptic potentials, in contrast to Medial Superior Olive neurons, traditionally viewed as the ultimate ITD-detectors. In vivo, inhibition blocks LSO excitation over an extremely short window, which, in vitro, required synaptically evoked inhibition. Light and electron microscopy revealed inhibitory synapses on the axon initial segment as the structural basis of this observation. These results reveal a neural vetoing mechanism with extreme temporal and spatial precision and establish the LSO as the primary nucleus for binaural processing of sound transients

Methane metabolism in the archaeal phylum Bathyarchaeota revealed by genome-centric metagenomics

Methanogenic and methanotrophic archaea play important roles in the global flux of methane. Culture-independent approaches are providing deeper insight into the diversity and evolution of methane-metabolizing microorganisms, but, until now, no compelling evidence has existed for methane metabolism in archaea outside the phylum Euryarchaeota. We performed metagenomic sequencing of a deep aquifer, recovering two near-complete genomes belonging to the archaeal phylum Bathyarchaeota (formerly known as the Miscellaneous Crenarchaeotal Group). These genomes contain divergent homologs of the genes necessary for methane metabolism, including those that encode the methyl–coenzyme M reductase (MCR) complex. Additional non-euryarchaeotal MCR-encoding genes identified in a range of environments suggest that unrecognized archaeal lineages may also contribute to global methane cycling. These findings indicate that methane metabolism arose before the last common ancestor of the Euryarchaeota and Bathyarchaeota

Tax avoidance as an anti-austerity issue: the progress of a protest issue through the public sphere

Theorists of left and right agree that periods of crisis are fertile times at which to precipitate change. However, protesters on the periphery of the public sphere must overcome barriers, or what Habermas called ‘sluice gates’, if their discourse is to be publicly and politically influential. This study of newspaper discourse and activity in parliament and the public sphere over a six year period takes tax justice campaigning in the UK as a case study, and in particular protest group UK Uncut’s attempt to mobilize opposition to austerity by advocating a crackdown on tax avoidance as an alternative to cuts. It finds that whilst UK Uncut successfully amplified existing arguments previously raised by experts, trade unions and the left-leaning press, austerity barely figured in debate about tax avoidance once it was picked up by other actors in the public sphere on the other side of the 'sluice gates'. The reasons for this were structural and discursive, related to the role and interests of receptive actors at the institutional centre of the public sphere, and their ability, along with the conservative press, to transform the moral framing of tax avoidance from the injustice of making the poor pay for the financial crisis through cuts, into the 'unfairness' of middle class earners paying higher taxes than wealthier individuals and corporations. The latter reifies the 'hardworking taxpayer', and implies a more instrumental and clientalistic relationship to the state, and an essentially neoliberal sense of fairness. Where neoliberal ideology was challenged, it was in social conservative terms – nationalist opposition to globalisation, framing multinational corporations as a threat to the domestic high street – rather than protesters’ social democratic challenge to market power and social injustice. This indicates how a progressive message from the periphery can be co-opted into the currently resurgent right-wing populism

Iterative algorithm versus analytic solutions of the parametrically driven dissipative quantum harmonic oscillator

We consider the Brownian motion of a quantum mechanical particle in a one-dimensional parabolic potential with periodically modulated curvature under the influence of a thermal heat bath. Analytic expressions for the time-dependent position and momentum variances are compared with results of an iterative algorithm, the so-called quasiadiabatic propagator path integral algorithm (QUAPI). We obtain good agreement over an extended range of parameters for this spatially continuous quantum system. These findings indicate the reliability of the algorithm also in cases for which analytic results may not be available a priori.Comment: 15 pages including 11 figures, one reference added, minor typos correcte