Systematic review of pain medicine content, teaching, and assessment in medical school curricula internationally

Introduction: Pain management is a major health care challenge in terms of the significant prevalence of pain and the negative consequences of poor management. Consequently, there have been international calls to improve pain medicine education for medical students. This systematic review examines the literature on pain medicine education at medical schools internationally, with a particular interest in studies that make reference to: a defined pain medicine curriculum, specific pain medicine learning objectives, dedicated pain education modules, core pain topics, medical specialties that teach pain medicine, elective study opportunities, hours allocated to teaching pain medicine during the curriculum, the status of pain medicine in the curriculum (compulsory or optional), as well as teaching, learning, and assessment methods. Methods: A systematic review was undertaken of relevant studies on pain medicine education for medical students published between January 1987 and May 2018 using PubMed, Medline, Excerpta Medica database (EMBASE), Education Resources Information Center (ERIC), and Google Scholar, and Best Evidence Medical Education (BEME) data bases. Results: Fourteen studies met the inclusion criteria. Evaluation of pain medicine curricula has been undertaken at 383 medical schools in Australia, New Zealand, the United States of America (USA), Canada, the United Kingdom (UK), and Europe. Pain medicine was mostly incorporated into medical courses such as anaesthesia or pharmacology, rather than presented as a dedicated pain medicine module. Ninety-six percent of medical schools in the UK and USA, and nearly 80% of medical schools in Europe had no compulsory dedicated teaching in pain medicine. On average, the median number of hours of pain content in the entire curriculum was 20 in Canada (2009), 20 in Australia and New Zealand (2018), 13 in the UK (2011), 12 in Europe (2012/2013), and 11 in the USA (2009). Neurophysiology and pharmacology pain topics were given priority by medical schools in all countries. Lectures, seminars, and case-based instruction were the teaching methods most commonly employed. When it was undertaken, medical schools mostly assessed student competency in pain medicine using written examinations rather than clinical assessments. Conclusions: This systematic review has revealed that pain medicine education at medical schools internationally does not adequately respond to societal needs in terms of the prevalence and public health impact of inadequately managed pain

Editorial

Non-pharmacological therapy for recurrent tachycardiaAlpha-adrenergic agonists in anaesthesia and analgesia The high price of becoming a docto

67,000 years of coastal engagement at Panga ya Saidi, eastern Africa

The antiquity and nature of coastal resource procurement is central to understanding human evolution and adaptations to complex environments. It has become increasingly apparent in global archaeological studies that the timing, characteristics, and trajectories of coastal resource use are highly variable. Within Africa, discussions of these issues have largely been based on the archaeological record from the south and northeast of the continent, with little evidence from eastern coastal areas leaving significant spatial and temporal gaps in our knowledge. Here, we present data from Panga ya Saidi, a limestone cave complex located 15 km from the modern Kenyan coast, which represents the first long-term sequence of coastal engagement from eastern Africa. Rather than attempting to distinguish between coastal resource use and coastal adaptations, we focus on coastal engagement as a means of characterising human relationships with marine environments and resources from this inland location. We use aquatic mollusc data spanning the past 67,000 years to document shifts in the acquisition, transportation, and discard of these materials, to better understand long-term trends in coastal engagement. Our results show pulses of coastal engagement beginning with low-intensity symbolism, and culminating in the consistent low-level transport of marine and freshwater food resources, emphasising a diverse relationship through time. Panga ya Saidi has the oldest stratified evidence of marine engagement in eastern Africa, and is the only site in Africa which documents coastal resources from the Late Pleistocene through the Holocene, highlighting the potential archaeological importance of peri-coastal sites to debates about marine resource relationships.Introduction Site location and description Materials and methods Results - PYS mollusc assemblage characteristics - Comparative trends in mollusc discard Discussion Conclusio

Iron Age hunting and herding in coastal eastern Africa: ZooMS identification of domesticates and wild bovids at Panga ya Saidi, Kenya

The morphological differentiation of African bovids in highly fragmented zooarchaeological assemblages is a major hindrance to reconstructing the nature and spread of pastoralism in sub-Saharan Africa. Here we employ collagen peptide mass fingerprinting, known as Zooarchaeology by Mass Spectrometry (ZooMS), coupled with recently published African ZooMS reference datasets, to identify domesticates and wild bovids in Iron Age assemblages at the cave site of Panga ya Saidi in southeast Kenya. Through ZooMS we have identified all three major African livestock—sheep (Ovis aries), goat (Capra hircus) and cattle (Bos taurus)—at the site for the first time. The results provide critical evidence for the use of domesticates by resident foraging populations during the Iron Age, the period associated with the arrival of food production in coastal Kenya. ZooMS results show that livestock at Panga ya Saidi form a minor component of the assemblage compared to wild bovids, demonstrating the persistence of hunting and the secondary role of acquiring livestock in hunter-gatherer foodways during the introduction of agro-pastoralism. This study sheds new light on the establishment of food production in coastal eastern Africa, particularly the role of interactions between hunter-gatherers and neighbouring agro-pastoral groups in what was a protracted regional transition to farming.1. Introduction 2. Background 2.1. Problems with differentiating domesticates in African zooarchaeology 2.2. ZooMS in Africa 2.3. Panga ya Saidi, southeastern Kenya 2.3.1. Ecological setting 2.3.2. Archaeological background 3. Materials and methods 3.1. Sample Selection 3.2. ZooMS protocol 4. Results 5. Discussion 5.1. The impact of domestic livestock on hunting economies at PYS 5.2. Livestock trading or herding? 5.3. The role of domesticates in forager-farmer interactions 5.4. Behavioural and ecological implications of klipspringers at PYS 6. Conclusio

Application of real-time PCR to quantify hepatitis B virus DNA in chronic carriers in The Gambia

BACKGROUND/AIM: The study aimed at developing a real-time quantitative PCR assay to monitor HBV serum virus load of chronic carriers enrolled in therapeutic trials. METHOD: Quantitative real-time PCR assay was carried out using SYBR-Green signal detection and primers specific to the S gene. Thermal cycling was performed in an ABi 5700 sequence detection system. The assay was calibrated against an international HBV DNA standard and inter- and intra-assay reproducibility determined. Levels of viral load were monitored for 1-year in lamivudine treated carriers. Correlation between HBV DNA levels and HBeAg sero-status was determined in untreated carriers. RESULTS: The qPCR assay showed good intra- and inter-assay reproducibility over a wide dynamic range (1.5 × 10(3 )to 1.5 × 10(8 )copies/mL) and correlated well with those from a commercial assay (r = 0.91, (p < 0.001). Viral load levels dropped dramatically but temporarily during and after a short course of lamivudine therapy. HBV DNA was a more reliable indicator of the presence of virus than HBe antigen and was detected in 77.0% (161/209) of HBeAg negative and in all HBeAg positive carriers. CONCLUSION: This method is reliable, accurate, and reproducible. HBV DNA Quantification by qPCR can be used to monitor the efficacy of HBV therapy and useful in understanding the natural history of HBV in an endemic area

Momentum transfer resolved memory in a magnetic system with perpendicular anisotropy

We have used resonant, coherent soft x-ray scattering to measure wave vector re- solved magnetic domain memory in Co/Pd multilayers. The technique uses angular cross correlation functions and can be applied to any system with circular annuli of constant values of scattering wave vector q. In our Co/Pd film, the memory exhibits a maximum at q = 0.0384 nm-1 near initial reversal that decreases in magnitude as the magnetization is further reversed. The peak is attributed to bubble domains that nucleate reproducibly near initial reversal and which grow into a labyrinth domain structure that is not reproduced from one magnetization cycle to the next

Liver Enzyme Abnormalities and Associated Risk Factors in HIV Patients on Efavirenz-Based HAART with or without Tuberculosis Co-Infection in Tanzania.

To investigate the timing, incidence, clinical presentation, pharmacokinetics and pharmacogenetic predictors for antiretroviral and anti-tuberculosis drug induced liver injury (DILI) in HIV patients with or without TB co-infection. A total of 473 treatment naïve HIV patients (253 HIV only and 220 with HIV-TB co-infection) were enrolled prospectively. Plasma efavirenz concentration and CYP2B6*6, CYP3A5*3, *6 and *7, ABCB1 3435C/T and SLCO1B1 genotypes were determined. Demographic, clinical and laboratory data were collected at baseline and up to 48 weeks of antiretroviral therapy. DILI case definition was according to Council for International Organizations of Medical Sciences (CIOMS). Incidence of DILI and identification of predictors was evaluated using Cox Proportional Hazards Model. The overall incidence of DILI was 7.8% (8.3 per 1000 person-week), being non-significantly higher among patients receiving concomitant anti-TB and HAART (10.0%, 10.7 per 1000 person-week) than those receiving HAART alone (5.9%, 6.3 per 1000 person-week). Frequency of CYP2B6*6 allele (p = 0.03) and CYP2B6*6/*6 genotype (p = 0.06) was significantly higher in patients with DILI than those without. Multivariate cox regression model indicated that CYP2B6*6/*6 genotype and anti-HCV IgG antibody positive as significant predictors of DILI. Median time to DILI was 2 weeks after HAART initiation and no DILI onset was observed after 12 weeks. No severe DILI was seen and the gain in CD4 was similar in patients with or without DILI. Antiretroviral and anti-tuberculosis DILI does occur in our setting, presenting early following HAART initiation. DILI seen is mild, transient and may not require treatment interruption. There is good tolerance to HAART and anti-TB with similar immunological outcomes. Genetic make-up mainly CYP2B6 genotype influences the development of efavirenz based HAART liver injury in Tanzanians

Spatial distribution of micrometre‐scale porosity and permeability across the damage zone of a reverse‐reactivated normal fault in a tight sandstone : Insights from the Otway Basin, SE Australia

This research forms part of a PhD project supported by the Australian Research Council [Discovery Project DP160101158] and through an Australian Government Research Training Program Scholarship. Dave Healy acknowledges the support of the Natural Environment Research Council (NERC, UK) through the award NE/N003063/1 ‘Quantifying the Anisotropy of Permeability in Stressed Rock’. This study was also funded by scholarships from the Petroleum Exploration Society of Australia and the Australian Petroleum Production and Exploration Association. We thank Gordon Holm for preparing thin sections and Colin Taylor for carrying out particle size measurements and mercury injection capillary pressure analyses. Aoife McFadden and David Kelsey from Adelaide Microscopy, Braden Morgan, and Sophie Harland are acknowledged for their assistance with laboratory work. Field assistants James Hall, Rowan Hansberry, and Lachlan Furness are also gratefully acknowledged for their assistance with sample collection. Discussions with Ian Duddy on the mineralogy of the Eumeralla Formation are also greatly appreciated. This forms TRaX record 416.Peer reviewedPublisher PD

'Cultural heritage and jazz festivals' special issue editors' introduction

Festivals claim an important place in Europe’s cultural ecology, with their dynamic and synergetic relationship to specific locations and cultural sites. European jazz festivals in particular offer a distinctive lens through which to explore key issues in heritage research, given their complex relationship to questions of race and diaspora, national identity, and cultural politics. In this special issue we present insights and findings from the EU JPI-Heritage Plus-funded project Cultural Heritage and Improvised Music in European Festivals (CHIME) which ran from 2015 to 2018. Drawing on jazz and improvised music festivals, CHIME explored how music plays a key role in the sonic refiguring of the urban and rural landscapes, and linked studies of cultural heritage to issues concerning national identity, cultural tourism, urban regeneration, and community engagement...