Kenya model: Development and implementation of an overseas study course on African wildlife ecology and management

The brochure declares: What better place to study a diversity of wildlife species and ecosystems than Kenya\u27s spectacular National Parks and Conservation Areas? Enticing! Exhilarating! A once in a life time experience! African Wildlife Ecology and Management in Kenya is an intensive two and a half week overseas study program offered by Michigan State University\u27s (MSU) Department of Fisheries and Wildlife. Through this hands-on experience, students apply wildlife management principles to issues in Kenya\u27s National Parks and Conservation Areas. Planning and coordination of this course requires a year\u27s worth of thoughtful preparation in order to provide students with a dynamic yet placid in-country experience. To better aid other educators and coordinators in development and implementation of similar courses, we present a detailed account of the history and evolution of African Wildlife Ecology and Management in Kenya. How was this course conceived? How was support garnered from the University? What is required for developing such a course? Furthermore, we present information on why different sites within Kenya were selected and how the order of visitation to these sites allows for a logical progression and increasingly more elaborate acquisition of knowledge of course material. Finally, we describe the various projects assigned to students and the rational for assigning them; the basis for using student groups throughout the in-country experience; the use of alternative forms of assessment to evaluate student learning; assigned readings and course packet development and contents; and implications of limited time and lack of technology while in-country

Subluxation: dogma or science?

Subluxation syndrome is a legitimate, potentially testable, theoretical construct for which there is little experimental evidence. Acceptable as hypothesis, the widespread assertion of the clinical meaningfulness of this notion brings ridicule from the scientific and health care communities and confusion within the chiropractic profession. We believe that an evidence-orientation among chiropractors requires that we distinguish between subluxation dogma vs. subluxation as the potential focus of clinical research. We lament efforts to generate unity within the profession through consensus statements concerning subluxation dogma, and believe that cultural authority will continue to elude us so long as we assert dogma as though it were validated clinical theory

Implication of strongly increased atmospheric methane concentrations for chemistry–climate connections

Methane (CH4) is the second-most important directly emitted greenhouse gas, the atmospheric concentration of which is influenced by human activities. In this study, numerical simulations with the chemistry–climate model (CCM) EMAC are performed, aiming to assess possible consequences of significantly enhanced CH4 concentrations in the Earth's atmosphere for the climate. We analyse experiments with 2×CH4 and 5×CH4 present-day (2010) mixing ratio and its quasi-instantaneous chemical impact on the atmosphere. The massive increase in CH4 strongly influences the tropospheric chemistry by reducing the OH abundance and thereby extending the CH4 lifetime as well as the residence time of other chemical substances. The region above the tropopause is impacted by a substantial rise in stratospheric water vapour (SWV). The stratospheric ozone (O3) column increases overall, but SWV-induced stratospheric cooling also leads to a enhanced ozone depletion in the Antarctic lower stratosphere. Regional patterns of ozone change are affected by modification of stratospheric dynamics, i.e. increased tropical upwelling and stronger meridional transport towards the polar regions. We calculate the net radiative impact (RI) of the 2×CH4 experiment to be 0.69&thinsp;W&thinsp;m−2, and for the 5×CH4 experiment to be 1.79&thinsp;W&thinsp;m−2. A substantial part of the RH is contributed by chemically induced O3 and SWV changes, in line with previous radiative forcing estimates. To our knowledge this is the first numerical study using a CCM with respect to 2- and 5-fold CH4 concentrations and it is therefore an overdue analysis as it emphasizes the impact of possible strong future CH4 emissions on atmospheric chemistry and its feedback on climate.</p

Search for quarks in cosmic rays with the Leeds cloud chamber

The central regions of cosmic-ray air showers near sea level have been studied with the Leeds cloud chamber for the possible occurrence of low-ionizing tracks. The average energy of the primary particles was a few times 106 GeV. Our current results give an upper limit to the "flux" of quarks of 1.2 x 10-11 cm-2 sec-1 sr-1 at a 90% confidence level. A simple model is used to obtain an upper limit to the production cross section versus quark mass.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/21994/1/0000406.pd

Editorial: Observational studies in ADHD: the effects of switching to modified-release methylphenidate preparations on clinical outcomes and adherence

Patients with ADHD may have better adherence to treatment with modified-release methylphenidate (MPH-MR) formulations, which are taken once daily, compared with immediate-release (IR) formulations, which need to be taken several times a day. Data on long-term outcomes such as adherence may be lacking from randomised controlled trials as these are usually only short-term. Observational studies, if performed and reported appropriately, can provide valuable long-term data on such outcomes, as well as additional information on effectiveness and efficiency, from a real-life setting. By reviewing previous observational studies that have investigated switching treatment from MPH-IR to MPH-MR, results from a new, naturalistic observational study, the OBSEER study, are put into context. We conclude that, based on observational trial data, switching from MPH-IR to MPH-MR is a valid clinical approach, with the potential for improved clinical outcome and treatment adherence

Adverse Drug Reactions in Hospital In-Patients: A Prospective Analysis of 3695 Patient-Episodes

Adverse drug reactions (ADRs) are a major cause of hospital admissions, but recent data on the incidence and clinical characteristics of ADRs which occur following hospital admission, are lacking. Patients admitted to twelve wards over a six-month period in 2005 were assessed for ADRs throughout their admission. Suspected ADRs were recorded and analysed for causality, severity and avoidability and whether they increased the length of stay. Multivariable analysis was undertaken to identify the risk factors for ADRs. The 5% significance level was used when assessing factors for inclusion in multivariable models. Out of the 3695 patient episodes assessed for ADRs, 545 (14.7%, 95% CI 13.6–15.9%) experienced one or more ADRs. Half of ADRs were definitely or possibly avoidable. The patients experiencing ADRs were more likely to be older, female, taking a larger number of medicines, and had a longer length of stay than those without ADRs. However, the only significant predictor of ADRs, from the multivariable analysis of a representative sample of patients, was the number of medicines taken by the patient with each additional medication multiplying the hazard of an ADR episode by 1.14 (95% CI 1.09, 1.20). ADRs directly increased length of stay in 147 (26.8%) patients. The drugs most frequently associated with ADRs were diuretics, opioid analgesics, and anticoagulants. In conclusion, approximately one in seven hospital in-patients experience an ADR, which is a significant cause of morbidity, increasing the length of stay of patients by an average of 0.25 days/patient admission episode. The overall burden of ADRs on hospitals is high, and effective intervention strategies are urgently needed to reduce this burden

An embedded longitudinal multi-faceted qualitative evaluation of a complex cluster randomized controlled trial aiming to reduce clinically important errors in medicines management in general practice

<p>Abstract</p> <p>Background</p> <p>There is a need to shed light on the pathways through which complex interventions mediate their effects in order to enable critical reflection on their transferability. We sought to explore and understand key stakeholder accounts of the acceptability, likely impact and strategies for optimizing and rolling-out a successful pharmacist-led information technology-enabled (PINCER) intervention, which substantially reduced the risk of clinically important errors in medicines management in primary care.</p> <p>Methods</p> <p>Data were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway), relevant documents, and focus group discussions following delivery of the PINCER intervention. Participants included PINCER pharmacists, general practice staff, researchers involved in the running of the trial, and primary care trust staff. PINCER pharmacists were interviewed at three different time-points during the delivery of the PINCER intervention. Analysis was thematic with diffusion of innovation theory providing a theoretical framework.</p> <p>Results</p> <p>We conducted 52 semi-structured telephone interviews and six focus group discussions with 30 additional participants. In addition, documentary data were collected from six pharmacist diaries, along with notes from four meetings of the PINCER pharmacists and feedback meetings from 34 practices. Key findings that helped to explain the success of the PINCER intervention included the perceived importance of focusing on prescribing errors to all stakeholders, and the credibility and appropriateness of a pharmacist-led intervention to address these shortcomings. Central to this was the face-to-face contact and relationship building between pharmacists and a range of practice staff, and pharmacists’ explicitly designated role as a change agent. However, important concerns were identified about the likely sustainability of this new model of delivering care, in the absence of an appropriate support network for pharmacists and career development pathways.</p> <p>Conclusions</p> <p>This embedded qualitative inquiry has helped to understand the complex organizational and social environment in which the trial was undertaken and the PINCER intervention was delivered. The longitudinal element has given insight into the dynamic changes and developments over time. Medication errors and ways to address these are high on stakeholders’ agendas. Our results further indicate that pharmacists were, because of their professional standing and skill-set, able to engage with the complex general practice environment and able to identify and manage many clinically important errors in medicines management. The transferability of the PINCER intervention approach, both in relation to other prescribing errors and to other practices, is likely to be high.</p