Teaching medical anthropology in UK medical schools: cultivating autoethnographic practice among medical students

oai:repository.canterbury.ac.uk:96w02Behavioural and social sciences (BSS) are a core component of undergraduate medical education in the United Kingdom. Despite the formal recognition of BSS by the UK’s General Medical Council (GMC), anthropology remains largely at the periphery in the medical curriculum. Medical students often describe it as ‘fluffy’ or as ‘common sense’, in comparison to biomedical learning content. To make anthropology more relevant and applicable to future clinical practice, we draw on ethnographic data (interviews, focus groups, field notes and reflective texts written by medical students) collected by an anthropologist during fieldwork in two UK medical schools. We suggest moving this content out of the preclinical phase and instead incorporating it into the clinical phase. Specifically, we propose that having students conduct a micro-autoethnography during the clinical phase brings together two crucial aspects of medical student training: BSS principles and formation of a professional identity. Embedding these concepts in this specific context will allow students to process tensions they may feel between interactions they observe in a clinical context and team versus what they have been formally taught. This process allows them to negotiate their own professional identity between practice and ideal while more robustly situating BSS content in a relevant and immediately applicable manner within the current constraints of the medical curriculum

Non-Amontons behavior of friction in single contacts

We report on the frictional properties of a single contact between a glassy polymer lens and a flat silica substrate covered either by a disordered or by a self-assembled alkylsilane monolayer. We find that, in contrast to common belief, the Amontons proportionality between frictional and normal stresses does not hold. Besides, we observe that the velocity dependence of the sliding stress is strongly sensitive to the structure of the silane layer. Analysis of the frictional rheology observed on both disordered and self-assembled monolayers suggests that dissipation is controlled by the plasticity of a glass-like interfacial layer in the former case, and by pinning of polymer chains on the substrate in the latter one.Comment: submitted to Eur. Phys. J.

Friction Laws for Elastic Nano-Scale Contacts

The effect of surface curvature on the law relating frictional forces F with normal load L is investigated by molecular dynamics simulations as a function of surface symmetry, adhesion, and contamination. Curved, non-adhering, dry, commensurate surfaces show a linear dependency, F proportional to L, similar to dry flat commensurate or amorphous surfaces and macroscopic surfaces. In contrast, curved, non-adhering, dry, amorphous surfaces show F proportional to L^(2/3) similar to friction force microscopes. In our model, adhesive effects are most adequately described by the Hertz plus offset model, as the simulations are confined to small contact radii. Curved lubricated or contaminated surfaces show again different behavior; details depend on how much of the contaminant gets squeezed out of the contact. Also, it is seen that the friction force in the lubricated case is mainly due to atoms at the entrance of the tip.Comment: 7 pages, 5 figures, submitted to Europhys. Let

Naïve and informed views on the nature of scientific inquiry in large-scale assessments: Two sides of the same coin or different currencies

Many models in the field of epistemic cognition conceptualize students' views as being on a continuum between the poles of naïve and informed views. Against this background, the aim of the present study was to find out whether views on the nature of scientific inquiry (NOSI views) should be conceptualized and quantitatively assessed in a more multiplistic manner, considering naïve and informed views in their own, separate dimensions. Based on a competence model defining three inquiry methods, we developed a Likert-scaled questionnaire containing 10 scales, each assessing one NOSI view. We administered the questionnaire to a sample of 802 students in the lower and upper levels of secondary school. Based on structural equation modeling, the analyses confirmed a 10-dimensional model, distinguishing between each naïve and informed views as the only adequate representation of the data. Latent class analysis and interview data revealed four profiles of NOSI views in the data, which differed with regard to their agreement or disagreement with different naïve and informed views. We interpret these findings as evidence that supports more multiplistic models, with relevance to conceptualizing, measuring, and fostering NOSI views. We derive future directions of nature of science and NOSI research linking basic and applied research using experimental studies. © 2019 The Author. Journal of Research in Science Teaching published by Wiley Periodicals, Inc

Mesenchymal Stem Cells in a Transgenic Mouse Model of Multiple System Atrophy: Immunomodulation and Neuroprotection

Mesenchymal stem cells (MSC) are currently strong candidates for cell-based therapies. They are well known for their differentiation potential and immunoregulatory properties and have been proven to be potentially effective in the treatment of a large variety of diseases, including neurodegenerative disorders. Currently there is no treatment that provides consistent long-term benefits for patients with multiple system atrophy (MSA), a fatal late onset α-synucleinopathy. Principally neuroprotective or regenerative strategies, including cell-based therapies, represent a powerful approach for treating MSA. In this study we investigated the efficacy of intravenously applied MSCs in terms of behavioural improvement, neuroprotection and modulation of neuroinflammation in the (PLP)-αsynuclein (αSYN) MSA model.MSCs were intravenously applied in aged (PLP)-αSYN transgenic mice. Behavioural analyses, defining fine motor coordination and balance capabilities as well as stride length analysis, were performed to measure behavioural outcome. Neuroprotection was assessed by quantifying TH neurons in the substantia nigra pars compacta (SNc). MSC treatment on neuroinflammation was analysed by cytokine measurements (IL-1α, IL-2, IL-4, IL-5, IL-6, IL-10, IL-17, GM-CSF, INFγ, MCP-1, TGF-β1, TNF-α) in brain lysates together with immunohistochemistry for T-cells and microglia. Four weeks post MSC treatment we observed neuroprotection in the SNc, as well as downregulation of cytokines involved in neuroinflammation. However, there was no behavioural improvement after MSC application.To our knowledge this is the first experimental approach of MSC treatment in a transgenic MSA mouse model. Our data suggest that intravenously infused MSCs have a potent effect on immunomodulation and neuroprotection. Our data warrant further studies to elucidate the efficacy of systemically administered MSCs in transgenic MSA models

Exploring the Impact of the First Wave of COVID-19 on Social Work Practice: A Qualitative Study in England, UK

The COVID-19 pandemic signalled a radical shift in health and social care services globally. In UK, many of the people with existing social care needs were identified as 'clinically vulnerable' to COVID-19. Those at greatest risk were encouraged to adhere to additional public health measures that inadvertently exacerbated social disadvantages. Social workers were challenged to 'dig deep' to continue to provide services as usual. However, problems implementing new ways of working were reported but not examined in-depth through research. Our study explored experiences and perceptions of social workers responding to the first wave (April-July 2020) of COVID-19, in England, UK. Interviews with thirteen social workers, all working in the West Midlands region, were conducted via telephone or online video. Transcripts were analysed using reflexive thematic analysis. We use 'managing uncertainty' as a central concept underpinning the four themes identified after analysis: (1) providing social care at a physical distance, (2) negotiating home/work boundaries, (3) managing emerging risks and (4) long-term implications for social work. We discuss our findings in the context of resilience and organisational adaptation. Social workers in our study demonstrated resilience in action and rapid adaptation to new practices, but equally expressed concern about short-term efficiencies being prioritised over individual service user needs. The COVID-19 pandemic signalled a dramatic shift in how health and social care services were delivered to members of the public. Social workers reported challenges implementing new ways of working during the first wave of COVID-19. However, such challenges received little coverage in the media or in research. This article explores the views and experiences of social workers responding to the first COVID-19 wave in England, UK (April-July 2020). Telephone and online interviews were carried out with thirteen social workers active in the West Midlands region. Social workers shared experiences of how they managed uncertainty-a core theme in the study. Interviewees described managing the uncertainty of: (1) providing social care at a physical distance, (2) negotiating home/work boundaries, (3) managing emerging risks and (4) contemplating the future of social work practice. Our study demonstrates how social work professionals adapted rapidly to new practices during the first wave. However, social workers raised concerns about the impact of short-term solutions on long-term needs of service users. Implications for research and practice are discussed with reference to key literature

Alternative Magnesium Sulfate Dosing Regimens for Women With Preeclampsia: A Population Pharmacokinetic Exposure-Response Modeling and Simulation Study

Magnesium sulfate is the anticonvulsant of choice for eclampsia prophylaxis and treatment; however, the recommended dosing regimens are costly and cumbersome and can be administered only by skilled health professionals. The objectives of this study were to develop a robust exposure-response model for the relationship between serum magnesium exposure and eclampsia using data from large studies of women with preeclampsia who received magnesium sulfate, and to predict eclampsia probabilities for standard and alternative (shorter treatment duration and/or fewer intramuscular injections) regimens. Exposure-response modeling and simulation were applied to existing data. A total of 10 280 women with preeclampsia who received magnesium sulfate or placebo were evaluated. An existing population pharmacokinetic model was used to estimate individual serum magnesium exposure. Logistic regression was applied to quantify the serum magnesium area under the curve-eclampsia rate relationship. Our exposure-response model-estimated eclampsia rates were comparable to observed rates. Several alternative regimens predicted magnesium peak concentration < 3.5 mmol/L (empiric safety threshold) and eclampsia rate ≤ 0.7% (observed response threshold), including 4 g intravenously plus 10 g intramuscularly followed by either 8 g intramuscularly every 6 hours × 3 doses or 10 g intramuscularly every 8 hours × 2 doses and 10 g intramuscularly every 8 hours × 3 doses. Several alternative magnesium sulfate regimens with comparable model-predicted efficacy and safety were identified that merit evaluation in confirmatory clinical trials

Neural circuits controlling behavior and autonomic functions in medicinal leeches

In the study of the neural circuits underlying behavior and autonomic functions, the stereotyped and accessible nervous system of medicinal leeches, Hirudo sp., has been particularly informative. These leeches express well-defined behaviors and autonomic movements which are amenable to investigation at the circuit and neuronal levels. In this review, we discuss some of the best understood of these movements and the circuits which underlie them, focusing on swimming, crawling and heartbeat. We also discuss the rudiments of decision-making: the selection between generally mutually exclusive behaviors at the neuronal level