Acknowledgements

Acknowledgements Journal of Medical Education Research Editorial Board is grateful to the following reviewers for contributing to JMER publications in 2022

Editorial

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Patient understanding of moles and skin cancer, and factors influencing presentation in primary care: a qualitative study.

BACKGROUND: Melanoma incidence in the UK has doubled over two decades, yet there is conflicting evidence about factors which prompt or delay patients seeking advice. AIM: To explore patient understanding of pigmented skin lesions (moles) and skin cancer, and factors which influence seeking help in primary care. METHOD: Semi-structured interviews with forty MoleMate Trial participants, analysed using the theoretical framework of the Safer-Andersen model of Total Patient Delay. RESULTS: Patient understanding and awareness was influenced by personal, family and friends' experiences of moles, skin cancer and other cancers, knowledge of risk factors, and the lay media. The route to consulting was complex and often iterative. For lesions that people could see, detecting and appraising change was influenced by comparisons with a normal mole on themselves, a family member, friend or image. Inferring illness came about with recognition of changes (particularly size) as serious, and associated 'internal' symptoms such as pain. For lesions that people could not see, family, friends and health professionals detected and appraised changes. Deciding to seek help was often prompted by another person or triggered by rapid or multiple changes in a mole. Three of four people subsequently diagnosed with melanoma did not seek help; instead, their GP opportunistically noticed the lesion. CONCLUSIONS: Changing moles are often perceived as trivial and not signifying possible skin cancer. This study contributes to current national strategies to improve patient awareness and earlier diagnosis of cancer by highlighting factors that can trigger or act as barriers to seeking help.(ISRCTN79932379).RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Professionalism: Informal Consultations about Skin Diseases

Introduction: “Informal consultation” refers to informal self-referral to clinicians for medical advice. This questionnaire-based study explores non-dermatology doctors’ experiences with informal consultations on skin diseases. Method: A 13-item questionnaire-based study was conducted in 2020, involving a convenience sample of doctors from a district general hospital. Doctors working in the dermatology department were excluded from the questionnaire. The numerical data derived from the questionnaire were analysed using descriptive statistics, and free text data were analysed using content analysis. Results: The questionnaire response rate was 29/33 (88%), consisting of 27 doctors-in-training and two medical consultants. Twenty-four of 29 (83%) respondents reported that they were asked to provide dermatological advice outside of healthcare settings. The main source of self-referrals was first-degree relatives, as reported by 23/29 (79%) respondents. Twenty-five of 29 (86%) did not document the advice provided. Conclusions: Non-dermatology doctors encounter informal consultations on skin diseases. These requests put a burden on the work–life balance of clinicians involved, and there are risks associated with mismanaging such requests. Doctors in training would benefit from support and guidance from their supervisors on how to navigate this professionalism issue safely

The graduate-entry medical student : challenges to transition through medical school

This study aims to make a sociological contribution to understanding the experience of medical students from graduate-entry medicine degree programmes. In this study, I asked the research question ‘what are the challenges experienced by graduate-entry medicine degree programme students during their transition through medical school training?’ Medical students from the University of Warwick Medical School graduate-entry medicine degree programme were invited to take part in this interview-based study. A volunteer sample of 21 medical students took part in a stage one semi-structured one-to-one interview. Fourteen of 21 medical students took part in a follow-up stage two interview between four to thirteen months later. Their interview transcripts were transcribed verbatim and analysed using thematic analysis. Results showed there were three key transition periods within the University of Warwick Medical School’s graduate-entry medicine degree programme. Medical students encountered a range of challenging issues throughout their medical school journey that could be categorised under three conceptual themes: challenges associated with the curriculum, challenges associated with their social role and generic life challenges. Learning, professional identity development and managing coping strategies were the three key challenging issues dominating their transition experience. These challenging issues were in keeping with my findings from literature review on the medical school experience of undergraduate-entry and graduate-entry students. This study has made one original sociological contribution to understanding the professionalism issue about how medical students manage health advice requests from their family and friends. The findings from this study could be useful to educators and medical schools in enhancing their student support services. It could also be useful to prospective and existing medical students in understanding the realities of undertaking a graduate-entry medicine degree programme

Coulomb drag in compressible quantum Hall states

We consider the Coulomb drag between two layers of two-dimensional electronic gases subject to a strong magnetic field. We first focus on the case in which the electronic density is such that the Landau level filling fraction $\nu$ in each layer is at, or close to, $\nu=1/2$. Discussing the coupling between the layers in purely electronic terms, we show that the unique dependence of the longitudinal conductivity on wave-vector, observed in surface acoustic waves experiments, leads to a very slow decay of density fluctuations. Consequently, it has a crucial effect on the Coulomb drag, as manifested in the transresistivity $\rho_D$. We find that the transresistivity is very large compared to its typical values at zero magnetic field, and that its temperature dependence is unique -- $\rho_D \propto T^{4/3}$. For filling factors at or close to $1/4$ and $3/4$ the transresistivity has the same $T$-dependence, and is larger than at $\nu = 1/2$. We calculate $\rho_D$ for the $\nu=3/2$ case and propose that it might shed light on the spin polarization of electrons at $\nu=3/2$. We compare our results to recent calculations of $\rho_D$ at $\nu=1/2$ where a composite fermion approach was used and a $T^{4/3}$-dependence was obtained. We conclude that what appears in the composite fermion language to be drag induced by Chern-Simons interaction is, physically, electronic Coulomb drag.Comment: 11 pages, REVTeX with two Postscript figure

Managing Injuries of the Neck Trial (MINT) : design of a randomised controlled trial of treatments for whiplash associated disorders

Background: A substantial proportion of patients with whiplash injuries develop chronic symptoms. However, the best treatment of acute injuries to prevent long-term problems is uncertain. A stepped care treatment pathway has been proposed, in which patients are given advice and education at their initial visit to the emergency department (ED), followed by review at three weeks and physiotherapy for those with persisting symptoms. MINT is a two-stage randomised controlled trial to evaluate two components of such a pathway: 1. use of The Whiplash Book versus usual advice when patients first attend the emergency department; 2. referral to physiotherapy versus reinforcement of advice for patients with continuing symptoms at three weeks. Methods: Evaluation of the Whiplash Book versus usual advice uses a cluster randomised design in emergency departments of eight NHS Trusts. Eligible patients are identified by clinicians in participating emergency departments and are sent a study questionnaire within a week of their ED attendance. Three thousand participants will be included. Patients with persisting symptoms three weeks after their ED attendance are eligible to join an individually randomised study of physiotherapy versus reinforcement of the advice given in ED. Six hundred participants will be randomised. Follow-up is at 4, 8 and 12 months after their ED attendance. Primary outcome is the Neck Disability Index (NDI), and secondary outcomes include quality of life and time to return to work and normal activities. An economic evaluation is being carried out. Conclusion: This paper describes the protocol and operational aspects of a complex intervention trial based in NHS emergency and physiotherapy departments, evaluating two components of a stepped-care approach to the treatment of whiplash injuries. The trial uses two randomisations, with the first stage being cluster randomised and the second individually randomised

Commodity single board computer clusters and their applications

© 2018 Current commodity Single Board Computers (SBCs) are sufficiently powerful to run mainstream operating systems and workloads. Many of these boards may be linked together, to create small, low-cost clusters that replicate some features of large data center clusters. The Raspberry Pi Foundation produces a series of SBCs with a price/performance ratio that makes SBC clusters viable, perhaps even expendable. These clusters are an enabler for Edge/Fog Compute, where processing is pushed out towards data sources, reducing bandwidth requirements and decentralizing the architecture. In this paper we investigate use cases driving the growth of SBC clusters, we examine the trends in future hardware developments, and discuss the potential of SBC clusters as a disruptive technology. Compared to traditional clusters, SBC clusters have a reduced footprint, are low-cost, and have low power requirements. This enables different models of deployment—particularly outside traditional data center environments. We discuss the applicability of existing software and management infrastructure to support exotic deployment scenarios and anticipate the next generation of SBC. We conclude that the SBC cluster is a new and distinct computational deployment paradigm, which is applicable to a wider range of scenarios than current clusters. It facilitates Internet of Things and Smart City systems and is potentially a game changer in pushing application logic out towards the network edge

Next generation single board clusters

Until recently, cluster computing was too expensive and too complex for commodity users. However the phenomenal popularity of single board computers like the Raspberry Pi has caused the emergence of the single board computer cluster. This demonstration will present a cheap, practical and portable Raspberry Pi cluster called Pi Stack. We will show pragmatic custom solutions to hardware issues, such as power distribution, and software issues, such as remote updating. We also sketch potential use cases for Pi Stack and other commodity single board computer cluster architectures