Health informatics in UK Medical Education: an online survey of current practice

OBJECTIVE: Health informatics has growing importance in clinical practice with successive General Medical Council recommendations. However, prior data suggest that undergraduate medical education largely neglects this area. An up-to-date, UK-wide view of health informatics training in medical schools is required. DESIGN: An online survey was developed using current guidance and recommendations of UK professional bodies. PARTICIPANTS AND SETTING: Senior academic staff and health informatics educators at all 34 UK medical schools were invited to complete the survey. MAIN OUTCOME AND MEASURES: Quantitative and qualitative data regarding health informatics in the undergraduate medical curriculum. RESULTS: A total of 26/34 (76%) of UK medical schools responded and 23 provided full information. Aspects most frequently mentioned were literature searching and research governance. Seventeen per cent of respondents felt there was little or no HI training, although clinical record keeping was addressed by all medical schools. Pedagogies used to teach health informatics were self-directed learning (78%) to lecture based (70%), seminars (70%), informal teaching in clinical settings (57%) and problem-based learning (22%). Health informatics was usually integrated vertically and horizontally across the curriculum (76%). Assessment and updates of the health informatics curriculum are limited (57 and 41%, respectively). Thirty-two per cent of respondents reported a low level of confidence among students to use health informatics as doctors. In the most up-to-date survey of health informatics teaching in UK medical schools, there are three major findings. First, the proportion of health informatics in the medical undergraduate curriculum is low. Second, there was variation in content, pedagogy and timing across medical schools. Third, health informatics is rarely assessed and course content is not regularly updated. CONCLUSIONS: There is a role for national guidelines and further research in this area of the curriculum which is rapidly gaining in prominence

Faxen relations in solids - a generalized approach to particle motion in elasticity and viscoelasticity

A movable inclusion in an elastic material oscillates as a rigid body with six degrees of freedom. Displacement/rotation and force/moment tensors which express the motion of the inclusion in terms of the displacement and force at arbitrary exterior points are introduced. Using reciprocity arguments two general identities are derived relating these tensors. Applications of the identities to spherical particles provide several new results, including simple expressions for the force and moment on the particle due to plane wave excitation.Comment: 11 pages, 4 figure

Antitumour activity of pembrolizumab in advanced mucosal melanoma: a post-hoc analysis of KEYNOTE-001, 002, 006.

BackgroundMucosal melanoma is an aggressive melanoma with poor prognosis. We assessed efficacy of pembrolizumab in patients with advanced mucosal melanoma in KEYNOTE-001 (NCT01295827), -002 (NCT01704287), and -006 (NCT01866319).MethodsPatients received pembrolizumab 2 mg/kg every 3 weeks (Q3W) or 10 mg/kg Q2W or Q3W. Response was assessed by independent central review per RECIST v1.1.Results1567 patients were treated and 84 (5%) had mucosal melanoma. Fifty-one of 84 were ipilimumab-naive. In patients with mucosal melanoma, the objective response rate (ORR) was 19% (95% CI 11-29%), with median duration of response (DOR) of 27.6 months (range 1.1 + to 27.6). Median progression-free survival (PFS) was 2.8 months (95% CI 2.7-2.8), with median overall survival (OS) of 11.3 months (7.7-16.6). ORR was 22% (95% CI 11-35%) and 15% (95% CI 5-32%) in ipilimumab-naive and ipilimumab-treated patients.ConclusionPembrolizumab provides durable antitumour activity in patients with advanced mucosal melanoma regardless of prior ipilimumab

Spotlight environmental sustainability: a strategic priority for NICE

This article provides the context for the ambition outlined in the the National Institute for Health and Care Excellence (NICE) 2021–2026 strategy to ‘lead globally on the potential to include environmental impact data in its guidance to reduce the carbon footprint of health and care’. Anthropogenic environmental changes pose a catastrophic risk to human health, with potential to widen national and global health inequalities. Recognising the fact that NICE guidance influences the way health and care is delivered and its consequent environmental impact, NICE has included environmental sustainability among its strategic priorities. This article outlines the work underway to meet this sustainability agenda at NICE

Attractiveness of periodic orbits in parametrically forced systemswith time-increasing friction

We consider dissipative one-dimensional systems subject to a periodic force and study numerically how a time-varying friction affects the dynamics. As a model system, particularly suited for numerical analysis, we investigate the driven cubic oscillator in the presence of friction. We find that, if the damping coefficient increases in time up to a final constant value, then the basins of attraction of the leading resonances are larger than they would have been if the coefficient had been fixed at that value since the beginning. From a quantitative point of view, the scenario depends both on the final value and the growth rate of the damping coefficient. The relevance of the results for the spin-orbit model are discussed in some detail.Comment: 30 pages, 6 figure

Channelized melt flow in downwelling mantle: Implications for 226Ra-210Pb disequilibria in arc magmas

We present the results of an analytical model of porous flow of viscous melt into a steadily dilating ‘‘channel’’ (defined as a cluster of smaller veins) in downwelling subarc mantle. The model predicts the pressure drop in the mantle wedge matrix surrounding the channel needed to drive melt flow as a function of position and time. Melt is sucked toward the dilatant region at a near-constant velocity (105 s1) until veins comprising the channel stop opening (t = t). Fluid elements that complete their journey within the time span t < t arrive at a channel. Our results make it possible to calculate the region of influence sampled by melt that surrounds the channel. This region is large compared to the model size of the channelized region driving flow. For a baseline dilation time of 1 year and channel half width of 2 m, melt can be sampled over an 80-m radius and has the opportunity to sample matrix material with potentially contrasting chemistry on geologically short timescales. Our mechanical results are consistent with a downgoing arc mantle wedge source region where melting and melt extraction by porous flow to a channel network are sufficiently rapid to preserve source-derived 238U-230Th-226Ra, and potentially also 226 Ra-210Pb, disequilibria, prior to magma ascent to the surface. Since this is the rate-determining step in the overall process, it allows the possibility that such short-lived disequilibria measured in arc rocks at the surface are derived from deep in the mantle wedge. Stresses due to partial melting do not appear capable of producing the desired sucking effect, while the order of magnitude rate of shear required to drive dilation of 107 s1 is much larger than values resulting from steady state subduction. We conclude that local deformation rates in excess of background plate tectonic rates are needed to ‘‘switch on’’ the dilatant channel network and to initiate the sucking effect

Elemental energy spectra of cosmic rays measured by CREAM-II

We present new measurements of the energy spectra of cosmic-ray (CR) nuclei from the second flight of the balloon-borne experiment CREAM (Cosmic Ray Energetics And Mass). The instrument (CREAM-II) was comprised of detectors based on different techniques (Cherenkov light, specific ionization in scintillators and silicon sensors) to provide a redundant charge identification and a thin ionization calorimeter capable of measuring the energy of cosmic rays up to several hundreds of TeV. The data analysis is described and the individual energy spectra of C, O, Ne, Mg, Si and Fe are reported up to ~ 10^14 eV. The spectral shape looks nearly the same for all the primary elements and can be expressed as a power law in energy E^{-2.66+/-0.04}. The nitrogen absolute intensity in the energy range 100-800 GeV/n is also measured.Comment: 4 pages, 3 figures, presented at ICRC 2009, Lodz, Polan

Measurements of cosmic-ray energy spectra with the 2nd CREAM flight

During its second Antarctic flight, the CREAM (Cosmic Ray Energetics And Mass) balloon experiment collected data for 28 days, measuring the charge and the energy of cosmic rays (CR) with a redundant system of particle identification and an imaging thin ionization calorimeter. Preliminary direct measurements of the absolute intensities of individual CR nuclei are reported in the elemental range from carbon to iron at very high energy.Comment: 4 pages, 3 figures, presented at XV International Symposium on Very High Energy Cosmic Ray Interactions (ISVHECRI 2008

A Global Perspective on Trends in Nature-Based Tourism

Falling attendance at United States and Japanese national parks has led to claims of a pervasive shift away from nature-based recreation. A global analysis, however, now suggests that while visit rates are declining slightly in some richer countries, elsewhere nature tourism is booming

Guiding neutral atoms around curves with lithographically patterned current-carrying wires

Laser-cooled neutral atoms from a low-velocity atomic source are guided via a magnetic field generated between two parallel wires on a glass substrate. The atoms bend around three curves, each with a 15-cm radius of curvature, while traveling along a 10-cm-long track. A maximum flux of 2*10^6 atoms/sec is achieved with a current density of 3*10^4 A/cm^2 in the 100x100-micrometer-cross-section wires. The kinetic energy of the guided atoms in one transverse dimension is measured to be 42 microKelvin.Comment: 9 page