Can online distance learning improve access to learning in conflict zones? The Oxford Psychiatry in Iraq (OxPIQ) experience

Psychiatry trainees in Iraq face many challenges that limit their immediate access to training opportunities. These include limited opportunities to attend international conferences due to visa restrictions, reduced access to evidence-based practice and guidelines and less experience in conducting quality improvement projects and audits. There are also issues related to their training programmes, including lack of regular meetings with supervisors and fewer opportunities for case-based discussions. Clinical Psychiatry is thus a potential key affected clinical domain due to the above factors. Technological advances in the field of e-learning created concepts such as Technology-enhanced or Web-based learning (TEL or WBL). These developments enabled the formation of “virtual teams” using an online platform. These teams overcome logistical geographical and other barriers to enable professionals to connect and learn from each other. This paper includes an appraisal of the TEL, looking at its advantages and challenges in meeting the needs of learners and educators. Also, we describe how we incorporated evidence-based and good practice guidelines on TEL use in these circumstances to the design, delivery and early evaluation of the distance learning programme. In our conclusion, we add to these and draw attention to the use of established online platforms (Medicine Africa in this case) and the importance of involving Iraqi Training leads, trainees and institutions in identifying trainee learning needs and supporting existing training provisions

RF Propagation Through Transparent Conductors In Energy Efficient Windows

Windows were traditionally used as a means of building access and egress for RF signals. However, the drive towards building energy efficiency now means that windows are frequently coated with thin layers of Transparent Conductors (TCs). TCs can let visible light energy pass virtually un-attenuated, but reflect longer wavelengths (typically from the infrared region), to keep buildings warmer in colder climates and cooler in warmer climates. However, the use of TCs has a negative impact on wireless propagation, which this paper reports on. Three commercially available windows are examined, with results showing that less than 1% of the signal passes in either direction. This result is taken from a series of measurement over a range of frequencies from 800 MHz to 6 GHz, both in a large hall and in the WIT anechoic chamber

Barriers and supports to implementation of MDI/spacer use in nine Canadian pediatric emergency departments: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Despite recent research supporting the use of metered dose inhalers with spacer devices (MDI/spacers) in pediatric emergency departments (PEDs) for acute exacerbations of asthma, uptake of this practice has been slow. The objectives of this study were to determine the barriers and supports to implementing MDI/spacer research and to identify factors associated with early and late adoption of MDI/spacers in Canadian PEDs.</p> <p>Methods</p> <p>Using a comparative case study design, we classified nine tertiary care pediatric hospital PEDs based on their stage of implementation. Data were collected using focus group interviews with physicians, registered nurses (RNs), and respiratory therapists (RTs), and individual interviews with both patient care and medical directors at each site. Initial coding was based on the Ottawa Model of Research Use (OMRU) categories of elements known to influence the uptake of innovations.</p> <p>Results</p> <p>One hundred and fifty healthcare professionals from nine different healthcare institutions participated in this study. Lack of leadership in the form of a research champion, a lack of consensus about the benefits of MDI/spacers among staff, perceived resistance from patients/parents, and perceived increased cost and workload associated with MDI/spacer use were the most prevalent barriers to the adoption of the MDI/spacer. Common strategies used by early-adopting sites included the active participation of all professional groups in the adoption process in addition to a well-planned and executed educational component for staff, patients, and families. Early adopter sites were also more likely to have the MDI/spacer included in a clinical protocol/pathway.</p> <p>Conclusion</p> <p>Potential barriers and supports to implementation have been identified that will help EDs adopt MDI/spacer use. Future interventions intended to increase MDI/spacer use in PEDs will need to be sensitive to the barriers identified in this study.</p

Remembering and forgetting the Scottish Highlands: Sir James Mackintosh and the forging of a British imperial identity

This article explores the formation of British imperial identity through a focus on the career of Sir James Mackintosh (1765–1832), a well-known Whig intellectual and imperial careerist who originally hailed from the Highlands of Scotland. Using Mackintosh's unpublished letters and autobiography, the article shows how he imagined and narrated his relationship to the Scottish Highlands from the vantage points of Bombay and London. In contrast to recent historiography that has focused on the translation of Scottish society, culture, and identity in British imperial spaces, this article argues that disidentification from the Highlands of Scotland and the erasure of different peoples, cultures, and textures of life was integral to Mackintosh's configuration of a British imperial identity

A rhetoric-in-context approach to building commitment to multiple strategic goals

There are still few explanations of the micro-level practices by which top managers influence employee commitment to multiple strategic goals. This paper argues that, through their language, top managers can construct a context for commitment to multiple strategic goals. We therefore propose a rhetoric-in-context approach to illuminate some of the micro practices through which top managers influence employee commitment. Based upon an empirical study of the rhetorical practices through which top managers influence academic commitment to multiple strategic goals in university contexts, we demonstrate relationships between rhetoric and context. Specifically, we show that rhetorical influences over commitment to multiple goals are associated with the historical context for multiple goals, the degree to which top managers' rhetoric instantiates a change in that context, and the internal consistency of the rhetorical practices used by top managers. Copyright © 2007 SAGE Publications

Leptin Does Not Directly Affect CNS Serotonin Neurons to Influence Appetite

Serotonin (5-HT) and leptin play important roles in the modulation of energy balance. Here we investigated mechanisms by which leptin might interact with CNS 5-HT pathways to influence appetite. Although some leptin receptor (LepRb) neurons lie close to 5-HT neurons in the dorsal raphe (DR), 5-HT neurons do not express LepRb. Indeed, while leptin hyperpolarizes some non-5-HT DR neurons, leptin does not alter the activity of DR 5-HT neurons. Furthermore, 5-HT depletion does not impair the anorectic effects of leptin. The serotonin transporter-cre allele (Sert(cre)) is expressed in 5-HT (and developmentally in some non-5-HT) neurons. While Sert(cre) promotes LepRb excision in a few LepRb neurons in the hypothalamus, it is not active in DR LepRb neurons, and neuron-specific Sert(cre)-mediated LepRb inactivation in mice does not alter body weight or adiposity. Thus, leptin does not directly influence 5-HT neurons and does not meaningfully modulate important appetite-related determinants via 5-HT neuron function

Commercial Arctic shipping through the Northeast Passage:routes, resources, governance, technology, and infrastructure

The Russian and Norwegian Arctic are gaining notoriety as an alternative maritime route connecting the Atlantic and Pacific Oceans and as sources of natural resources. The renewed interest in the Northeast Passage or the Northern Sea Route is fueled by a recession of Arctic sea ice coupled with the discovery of new natural resources at a time when emerging and global markets are in growing demand for them. Driven by the expectation of potential future economic importance of the region, political interest and governance has been rapidly developing, mostly within the Arctic Council. However, this paper argues that optimism regarding the potential of Arctic routes as an alternative to the Suez Canal is overstated. The route involves many challenges: jurisdictional disputes create political uncertainties; shallow waters limit ship size; lack of modern deepwater ports and search and rescue (SAR) capabilities requires ships to have higher standards of autonomy and safety; harsh weather conditions and free-floating ice make navigation more difficult and schedules more variable; and more expensive ship construction and operation costs lessen the economic viability of the route. Technological advances and infrastructure investments may ameliorate navigational challenges, enabling increased shipping of natural resources from the Arctic to global markets.Albert Buixadé Farré, Scott R. Stephenson, Linling Chen, Michael Czub, Ying Dai, Denis Demchev, Yaroslav Efimov, Piotr Graczyk, Henrik Grythe, Kathrin Keil, Niku Kivekäs, Naresh Kumar, Nengye Liu, Igor Matelenok, Mari Myksvoll, Derek O'Leary, Julia Olsen, Sachin Pavithran.A.P., Edward Petersen, Andreas Raspotnik, Ivan Ryzhov, Jan Solski, Lingling Suo, Caroline Troein, Vilena Valeeva, Jaap van Rijckevorsel and Jonathan Wightin

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field