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

Realising the right of access to water: pipe dream or watershed?

The article assesses the implications of the Grootboom judgment on the right of access to water. The free basic water policy intends six free kilolitres of water per household per month to be funded from the equitable share and internal cross-subsidies. No additional funds are available for the provision of free water. This creates serious problems in rural communities that do not have sufficient high volume users to ensure cross-subsidisation. For most urban working class households six kilolitres of water is insufficient. Legislation dealing with water tariffs calls for a balance between cost recovery and access to basic services. The 'reasonableness' of this principle can be disputed in the light of high unemployment and poverty rates. A recent judgment confirms the principle that disconnection is a prima facie breach of the right of access to water. The onus is on the state to justify the disconnection. Human dignity is placed at the centre of the test of whether state action is reasonable, and being deprived of a basic supply of water strips people of their dignity.Department of HE and Training approved lis

Realising the right of access to water: Pipe dream or watershed?

No Abstract

The prehistoric people from Sigatoka : an analysis of skeletal and dental traits as evidence of adaptation

The biological relationships of Pacific people has long been the subject of conjecture and research. Yet very few skeletons older than 1000 years have been recovered and studied. The excavation of 63 skeletons from the Sigatoka Dune Site, (VL16/1) Fiji has provided a unique opportunity to examine a discrete skeletal population dated to circa 180 AD. The study of the Sigatoka population focuses on four areas. One focus compares sex differences in the Sigatoka population using data provided by analyses of census, health, and pathology. Secondly, the distribution of burials is analysed using biological data. A third focus compares the Sigatoka with skeletal and anthropometric data obtained from Pacific populations. The fourth focus examines selective forces which may have influenced the Sigatoka body form. The people from Sigatoka appear to have experienced few episodes of growth disruption, nor is there bony evidence of infectious diseases. In the absence of deleterious health factors, the Sigatoka people were able to obtain comparatively tall statures and heavy body mass. Mean age at death is around 30 years of age. However, evidence of good health suggests that the average length of life of the entire population may have been around 40 years of age. Some of the bony pathologies present are argued to be effected by cultural activities determined by sex and social status. The consequences of these pathologies compromised health and may have contributed to an earlier age of death in some individuals. Social hierarchy is also implied by the location and distribution of burials. Heavier, taller, and older males were buried at the highest point of the burial ground. These differences indicate a society which was stratified and complex. The ability to draw firm conclusions of affinity from comparisons between Sigatoka and Pacific populations are limited by the vagaries genetics, environment, and limited sample sizes. However, there are indications that the Sigatoka people have close skeletal affinity with Lapita associated skeletons. Strong similarities in body form and skeletal traits also seem to exist with most Polynesians groups but not with non-Polynesian populations. Furthermore, significant skeletal differences occur between Sigatoka and recent Fijians. The extent of these differences and the time frame in which change took place are argued to be a consequence of frequent and perhaps widespread contact from the west, probably Vanuatu. The skeletal characteristics and body form of the Sigatoka people are suggested to reflect an adaptation to a cooler environment than contemporary tropical Fiji. Their body form fits in with models which suggest an adaptation to a cool marine environment. However, cultural mechanisms may have also contributed to the evolution of the Sigatoka body form

Action, entropy and pair creation rate of charged black holes in de Sitter space

We compute and clarify the interpretation of the on-shell Euclidean action for Reissner-Nordstr\"{o}m black holes in de Sitter space. We show the on-shell action is minus the sum of the black hole and cosmological horizon entropy for arbitrary mass and charge in any number of dimensions. This unifying expression helps to clear up a confusion about the Euclidean actions of extremal and ultracold black holes in de Sitter, as they can be understood as special cases of the general expression. We then use this result to estimate the probability for the pair creation of black holes with arbitrary mass and charge in an empty de Sitter background, by employing the formalism of constrained instantons. Finally, we comment that the decay of charged de Sitter black holes is expected to be governed by the gradient flow of the entropy function, and that as a consequence, as long as the regime of light, superradiant, rapid charge emission is excluded, the effective decay may be described by the tunneling formalism.Comment: 27 pages, 9 figure

On the Euclidean Action of de Sitter Black Holes and Constrained Instantons

We compute the on-shell Euclidean action of Schwarzschild-de Sitter black holes, and take their contributions in the gravitational path integral into account using the formalism of constrained instantons. Although Euclidean de Sitter black hole geometries have conical singularities for generic masses, their on-shell action is finite and is shown to be independent of the Euclidean time periodicity and equal to minus the sum of the black hole and cosmological horizon entropy. We apply this result to compute the probability for a nonrotating, neutral arbitrary mass black hole to nucleate spontaneously in empty de Sitter space, which separates into a constant and a "non-perturbative" contribution, the latter corresponding to the proper saddle-point instanton in the Nariai limit. We also speculate on some further applications of our results, most notably as potential non-perturbative corrections to correlators in the de Sitter vacuum.Comment: 34 pages, 15 figures, added further references and clarifications. Revised version for SciPos

Towards the Verification of Human-Robot Teams

Human-Agent collaboration is increasingly important. Not only do high-profile activities such as NASA missions to Mars intend to employ such teams, but our everyday activities involving interaction with computational devices falls into this category. In many of these scenarios, we are expected to trust that the agents will do what we expect and that the agents and humans will work together as expected. But how can we be sure? In this paper, we bring together previous work on the verification of multi-agent systems with work on the modelling of human-agent teamwork. Specifically, we target human-robot teamwork. This paper provides an outline of the way we are using formal verification techniques in order to analyse such collaborative activities. A particular application is the analysis of human-robot teams intended for use in future space exploration