Gender Matters:Understanding Transitions in Surgical Education

INTRODUCTION: Diverse transitions are elemental to medical career trajectories. The effective navigation of such transitions influences a sense of belonging and wellbeing, positive relationships, and good engagement and attainment within new contexts. Using Multiple and Multidimensional Transitions (MMT) theory as an analytical lens, this paper aims to answer the research question: “What gendered transitions do female surgeons experience, and how do these gendered transitions impact them?” METHODS: We conducted a qualitative study drawing on narrative inquiry, with face-to-face and online semi-structured interviews with 29 female surgeons across nine surgical specialities in Ireland and Scotland. This paper is part of a larger study including male surgeons, other colleagues and patients of female surgeons. The female surgeons in this paper were purposively sampled using maximum variation sampling across several levels (consultants, trainees and middle-grade doctors), as well as six who had transitioned out of surgery. Framework analysis was employed to interrogate the interview data. RESULTS: Five overarching types of transitions were identified across surgical education but only three of these transitions—work, culture and health—were primarily experienced by female surgeons (not male surgeons so were considered gendered), thereby impacting social, academic, and psychological domains. The remaining two types of transition—education and geography—were seemingly experienced equally by female and male surgeons, so are beyond the scope of this paper focused on female surgeons’ gendered experiences. CONCLUSION: This novel qualitative study drawing on MMT theory illustrates how multiple gendered transitions interact and impact female surgeons across the surgical education continuum. Aligned with MMT theory, family members and others are also purportedly affected by female surgeons’ transitions. Healthcare educators, leaders and policymakers need to better understand gendered transitions and their impacts to improve support for female surgical trainees on their educational journeys

Fire and grazing determined grasslands of central Madagascar represent ancient assemblages

The ecology of Madagascar's grasslands is under-investigated and the dearth of ecological understanding of how disturbance by fire and grazing shapes these grasslands stems from a perception that disturbance shaped Malagasy grasslands only after human arrival. However, worldwide, fire and grazing shape tropical grasslands over ecological and evolutionary timescales, and it is curious Madagascar should be a global anomaly. We examined the functional and community ecology of Madagascar's grasslands across 71 communities in the Central Highlands. Combining multivariate abundance models of community composition and clustering of grass functional traits, we identified distinct grass assemblages each shaped by fire or grazing. The fire-maintained assemblage is primarily composed of tall caespitose species with narrow leaves and low bulk density. By contrast, the grazer-maintained assemblage is characterized by mat-forming, high bulk density grasses with wide leaves. Within each assemblage, levels of endemism, diversity and grass ages support these as ancient assemblages. Grazer-dependent grasses can only have co-evolved with a now-extinct megafauna. Ironically, the human introduction of cattle probably introduced a megafaunal substitute facilitating modern day persistence of a grazer-maintained grass assemblage in an otherwise defaunated landscape, where these landscapes now support the livelihoods of millions of people

Population modelling and genetics of a critically endangered Madagascan palm Tahina spectabilis.

Madagascar is home to 208 indigenous palm species, almost all of them endemic and >80% of which are endangered. We undertook complete population census and sampling for genetic analysis of a relatively recently discovered giant fan palm, the Critically Endangered Tahina spectablis in 2008 and 2016. Our 2016 study included newly discovered populations and added to our genetic study. We incorporated these new populations into species distribution niche model (SDM) and projected these onto maps of the region. We developed population matrix models based on observed demographic data to model population change and predict the species vulnerability to extinction by undertaking population viability analysis (PVA). We investigated the potential conservation value of reintroduced planted populations within the species potential suitable habitat. We found that the population studied in 2008 had grown in size due to seedling regeneration but had declined in the number of reproductively mature plants, and we were able to estimate that the species reproduces and dies after approximately 70 years. Our models suggest that if the habitat where it resides continues to be protected the species is unlikely to go extinct due to inherent population decline and that it will likely experience significant population growth after approximately 80 years due to the reproductive and life cycle attributes of the species. The newly discovered populations contain more genetic diversity than the first discovered southern population which is genetically depauperate. The species appears to demonstrate a pattern of dispersal leading to isolated founder plants which may eventually lead to population development depending on local establishment opportunities. The conservation efforts currently put in place including the reintroduction of plants within the species potential suitable habitat if maintained are thought likely to enable the species to sustain itself but it remains vulnerable to anthropogenic impacts

Smell of Infection:a novel, non-invasive method for detection of fish excretory- secretory proteins

Chemical signals are produced by aquatic organisms following predatory attacks or perturbations such as parasitic infection. Ectoparasites feeding on fish hosts are likely to cause release of similar alarm cues into the environment due to the stress, wounding, and immune response stimulated upon infection. Alarm cues are often released in the form of proteins, antimicrobial peptides, and immunoglobulins that provide important insights into bodily function and infection status. Here we outline a noninvasive method to identify potential chemical cues associated with infection in fish by extracting, purifying, and characterizing proteins from water samples from cultured fish. Gel free proteomic methods were deemed the most suitable for protein detection in saline water samples. It was confirmed that teleost proteins can be characterized from water and that variation in protein profiles could be detected between infected and uninfected individuals and fish and parasite only water samples. Our novel assay provides a noninvasive method for assessing the health condition of both wild and farmed aquatic organisms. Similar to environmental DNA monitoring methods, these proteomic techniques could provide an important tool in applied ecology and aquatic biology

Gut Microbiome Perturbations Induced by Bacterial Infection Affect Arsenic Biotransformation

Exposure to arsenic affects large human populations worldwide and has been associated with a long list of human diseases, including skin, bladder, lung, and liver cancers, diabetes, and cardiovascular disorders. In addition, there are large individual differences in susceptibility to arsenic-induced diseases, which are frequently associated with different patterns of arsenic metabolism. Several underlying mechanisms, such as genetic polymorphisms and epigenetics, have been proposed, as these factors closely impact the individuals’ capacity to metabolize arsenic. In this context, the role of the gut microbiome in directly metabolizing arsenic and triggering systemic responses in diverse organs raises the possibility that perturbations of the gut microbial communities affect the spectrum of metabolized arsenic species and subsequent toxicological effects. In this study, we used an animal model with an altered gut microbiome induced by bacterial infection, 16S rRNA gene sequencing, and inductively coupled plasma mass spectrometry-based arsenic speciation to examine the effect of gut microbiome perturbations on the biotransformation of arsenic. Metagenomics sequencing revealed that bacterial infection significantly perturbed the gut microbiome composition in C57BL/6 mice, which in turn resulted in altered spectra of arsenic metabolites in urine, with inorganic arsenic species and methylated and thiolated arsenic being perturbed. These data clearly illustrated that gut microbiome phenotypes significantly affected arsenic metabolic reactions, including reduction, methylation, and thiolation. These findings improve our understanding of how infectious diseases and environmental exposure interact and may also provide novel insight regarding the gut microbiome composition as a new risk factor of individual susceptibility to environmental chemicals.National Institute of Environmental Health Sciences (Massachusetts Institute of Technology. Center for Environmental Health Sciences Grant P30 ES002109)National Institute of Environmental Health Sciences (University of North Carolina. Center for Environmental Health and Susceptibility Grant P30 ES010126

Evaluating a strategy to assist undergraduate healthcare students to gain insights into the value of interprofessional education experiences from recently qualified healthcare professionals

This mini project has been funded by The Higher Education Academy: Health Sciences and Practice (January 2010 - July 2011).LondonNumerous studies have highlighted the complexity of preparing undergraduate healthcare professional for interprofessional practice (Reeves, et all 2007). A significant challenge is one of perceived relevance of undergraduates in relating interprofessional education experiences to the realities of practice (Johnson 2005). Longitudinal survey indicate the importance of the readiness of different groups of students to learn (Coster et al 2008). Thus if student s can gain insights into the purpose and application of interprofessional education to their future practice from those who have recently gone before they may be more willing to engage with such learning opportunities. This exploratory pilot study aimed to evaluate a strategy designed to assist undergraduate healthcare students to gain insights from recently qualified healthcare professionals into the value of pre-registration Interprofessional Education (IPE) experiences. The secondary aims of the study were to enable participating undergraduate healthcare students develop research skills and to examine how the views from the healthcare professionals could inform the development of pre-registration IPE.sch_phyArmitage, H., Connolly, J. and Pitt, R. 2008. Developing sustainable models of interprofessional learning in practice - The TUILIP project. Nurse Education in Practice, 8, p. 276-282. Ateah, C.A., Snow, W., Wener, P., MacDonald, L., Metge, C., Davis, P., Fricke, M., Ludwig, S. and Anderson, J. 2011. Stereotyping as a barrier to collaboration: Does interprofessional education make a difference? Nurse Education Today, 31, p.208-213. Atherton, J. S. 2009. Learning and Teaching; About the site [online] Available: http://www.learningandteaching.info/learning/whatlearn.htm [Accessed: 26 May 2011] Barr, H. 2009. Interprofessional education as an emerging concept. In: Bluteau, P. and Jackson, A. eds. Interprofessional education: making it happen. Basingstoke: Palgrave Macmillan: 3-36. Boyatzis, R.E. 1998. Transforming qualitative information: thematic analysis and code development. Sage, Thousand Oaks, CA. Bristol Royal Infirmary Inquiry. 2001. Learning from Bristol: The Report of the Public Inquiry into Children's Heart Surgery at the Bristol Royal Infirmary 1984-1995. The Stationary Office, London. Bryman, A. 2001. Social research methods. Oxford University Press, Oxford. CAIPE 1997. Interprofessional education - a definition. CAIPE Bulletin, 13, 19. Clouder, L. 2003. Becoming professional: exploring the complexities of professional socialization in health and social care. Learning in Health and Social Care, 2 (4) p.213-222. 55 Coster, S., Norman, I., Murrells, T., Kitchen, S., Meerabeau, E., Sooboodoo, E and d'Avray, L. 2008. Interprofessional attitudes amongst undergraduate students in the health professions: A longitudinal questionnaire survey. International Journal of Nursing Studies. 45, (11), p.1667-1681. Craddock, D. 2010. Students' attitudes towards interprofessional education across professional groups: Lessons learnt from a national study. In, 2nd International Interprofessional Health and Social Care Conference, Manchester, GB, 06 - 07 Jul 2010..Available from: http://eprints.soton.ac.uk/165533/ [Accessed 1st December 2010] Curran, V.R., Sharpe, D., Forristall, J. and Flynn, K. 2008. Attitudes of health sciences students towards interprofessional teamwork and education. Learning in Health and Social Care, 7 (3), p.146-156. Davies, K., Harrison, D.L., Clouder, D.C., Gilchrist, M., McFarland, L. and Earland, J. 2011. Making the transition from physiotherapy student to interprofessional team member. Physiotherapy, 97: 139-144. Department of Health 2001. Investment and reform for NHS staff - taking forward the NHS plan. London: Department of Health. Denzin, N.K. and Lincoln, Y.S. 1998. The landscape of qualitative research - theories and issues. Sage Publications, London. Earland, J., Gilchrist, M., McFarland, L. and Harrison, K. 2011. Dietetics students' perceptions and experiences of interprofessional education. The Journal of Human Nutrition and Dietetics, 24, p.135-143. Forte, A. and Fowler, P. 2009. Participation in interprofessional education: An evaluation of student and staff experiences. Journal of Interprofessional Care, 23 (1), p.58-66. Freeth, D. Reeves, D., Koppel, I., Hammick, M. and Barr. H. 2005. Evaluating Interprofessional Education: A Self-Help Guide: Occasional Paper no. 5. Higher Education Academy: Health Sciences and Practice Network. 56 Gibson, M., Diack, L. Healey, T., Bond, C. and McKenzie, H. 2008. The Aberdeen Interprofessional Health and Social Care Education Initiative - Final Report to the Scottish Government. The Robert Gordon University, Aberdeen and University of Aberdeen. Available from: http://www.caipe.org.uk/resources/ [Accessed 5th January 2011] GMC 2009. Medical students: professional values and fitness to practice. General Medical Council. Hammick, M., Freeth, D., Koppel, I., Reeves, S. and Barr, H. 2007. A best evidence systematic review of interprofessional education: BEME Guide no.9. Medical Teacher, 29: 735-751. Hoffman, S.J., Rosenfield, D., and Naismith, L. 2009. .What attracts students to interprofessional education and other health care reform initiatives? Journal of Allied Health, 38(3), p.e75-e78. Hoffman, S.J., Rosenfield, D., Gilbert, J.H. and Oandasan, I.F. 2008. .Student leadership in interprofessional education: benefits, challenges and implications for educators, researchers and policymakers. Medical Education, 42(7), p.654-61. House of Commons Health Committee (2003) The Veronica Climbi Inquiry Report; Sixth Report of Session 2002-3. Available online: http://www.publications.parliament.uk/pa/cm200203/cmselect/cmhealth/570/570.pdf [Accessed 11th August 2010] HPC. 2008. Standards of conduct, performance and ethics. Health Professional Council. Hylin, U., Lonka, K. and Ponzer, S. 2011. Students' approaches to learning in clinical interprofessional context. Medical Teacher, 33: e204-210. Jarvis, P., Holford, J. and Griffin, C. 1998. The theory and practice of learning. London: Kogan Page. 57 Jasper, M. 2003. Foundations in nursing and health care: beginning reflective practice. Cheltenham: Nelson Thornes Ltd. Johnson, R. 2005. Exploring students' views of interprofessional education: 1 year on. International Journal of Therapy and Rehabilitation, 12 (5), p.215-221. Langton, H. 2009. Interprofessional education in Higher Education Institutions: models, pedagogies and realities. In: Bluteau, P. and Jackson, A. (eds) Interprofessional education: making it happen. Basingstoke: Palgrave Macmillan: 37-58. Mackay, D.J. 2002. Interprofessional education: An action learning approach to the development and evaluation of a pilot project at undergraduate level. PhD Thesis. University of Salford. Available from: http://usir.salford.ac.uk/2037/ [Accessed 15th January 2011] NMC 2008. The code: standards of conduct, performance and ethics for nurses and midwives. Nursing and Midwifery Council. Oandasan, I.O., Reeves, S. 2005. Key elements for interprofessional education, part 2: factors, processes, outcomes. Journal of Interprofessional Care, 19 (S1), p.39-48. O'Halloran, C., Hean, S., Humphries, D. and Macleod-Clark, J. 2006. Developing common learning: The New Generation Project undergraduate curriculum model. Journal of Interprofessional Care, 20, p.12-28. Olenick, M., Ryan Allen, L. and Smego, R.A. Jr. 2010. Interprofessional education: a concept analysis. Advances in Medical Education and Practice, 1: 75-84. Petticrew, M. and Roberts, H. 2006. Systematic reviews in the social sciences: a practical guide. Oxford: Blackwell Publishing. Pollard, K. 2009. Student engagement in interprofessional working in practice placement settings. Journal of Clinical Nursing, 18, p.2846-2856. 58 Pollard, K., Rickaby, C. and Miers, M. 2008. Evaluating student learning in an interprofessional curriculum: the relevance of pre-qualifying inter-professional education for future professional practice. Project Report. Health Sciences and Practice, The Higher Education Academy. Available online at: https://eprints.uwe.ac.uk/7240/ [Accessed: 25th June 2010] Pollard, K.C. and Miers, M.E. 2008. From students to professionals: Results of a longitudinal study of attitudes to pre-qualifying collaborative learning and working in health and social care in the United Kingdom. Journal of Interprofessional Care, 22 (4), p.399-416. Pollard, K.C., Miers, M.E., Gilchrist, M, and Sayers, A. 2006. A comparison of interprofessional perceptions and working relationships among health and social care students: the results of a 3-year intervention. Health and Social Care in the Community, 14 (6), p.541-552. Quality Assurance Agency (QAA) 2010. Statement of common purpose for subject benchmark statements for the health and social care professions. Available from: http://www.qaa.ac.uk/academicinfrastructure/benchmark/health/StatementofCommonPurpose06.pdf [Accessed 15 April 2011] Reeves and Freeth, 2002. The London Training ward: an innovative interprofessional learning initiative. Journal of Interprofessional Care, 16 (1), p41-52. Reeves, S., Goldman, J., Gilbert, J., Tepper, J., Silver, I., Suter, E and Zwarenstein, M. 2011. A scoping review to improve conceptual clarity of interprofessional interventions. Journal of Interprofessional Care, 25: 167-174. Reeves, S., Zwarenstein, M., Goldman, J., Barr, H., Freeth, D., Hammick, M. and Koppel, I. 2008. Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD002213. [DOI: 10.1002/14651858.CD002213.pub2.]. Reeves, S., Zwarenstein, M., Goldman, J., Barr, H., Freeth, D., Koppel, I. and Hammick, M. 2010. The effectiveness of interprofessional education: Key findings from a new systematic review. Journal of Interprofessional Care, 24(3), p.230-241. 59 Remington, T.L., Foulk, M.A. and Williams, B.C. 2006. Evaluation of Evidence for Interprofessional Education. American Journal of Pharmaceutical Education, 70 (3) Article 66. Robson, M. and Kitchen, S.S. 2007. Exploring physiotherapy students' experiences of interprofessional collaboration in the clinical setting: A critical incident study. Journal of Interprofessional Care, 21 (1) p.95-109. Rosenfield, D., Oandasan, I. and Reeves, S. 2011. Perceptions versus reality: a qualitative study of students' expectations and experiences of interprofessional education. Medical Education, 45: 471-477. Santy, J., Beadle, M. and Needham, Y. 2009. Using an online case conference to facilitate interprofessional learning. Nurse Education in Practice, 9, p.383-387. Scottish Government 2007. Better health, better care: planning tomorrow's workforce today. Scottish Government. Silverman, D. 1993. Interpreting qualitative data: methods for analysing talk, text and interaction. Sage, London. Strauss, A. and Corbin, J. 1998. Basics of qualitative research: techniques and procedures for developing grounded theory. Sage, London. The Combined Universities Interprofessional Learning Unit. 2005. Combined Universities Interprofessional Learning Unit: Final Report. Available from: www.sheffield.ac.uk/cuilu [Accessed 27th March 2010] The Lord Laming Report. 2009. The Protection of Children in England: A Progress Report. London: The Stationary Office. Available from: http://news.bbc.co.uk/1/shared/bsp/hi/pdfs/12_03_09_children.pdf. [Accessed: November 2010] Thompson, C. 2010 Do interprofessional education and problem based learning work together? The Clinical Teacher, 7, p.197-201. 60 WHO 2010. Framework for Action on Interprofessional Education and Collaborative Practice. World Health Organisation. WHO Study Group on Interprofessional Education and Collaborative Practice. 2008. Interprofessional Education and Collaborative Practice Glossary. Available from: http://cihc.wikispaces.com/Interprofessional+Glossary [Accessed: 5th August 2010]pub2875pu

How collective action produces psychological change and how that change endures over time: a case study of an environmental campaign

Previous research on collective action has suggested that both intra‐ and intergroup interactions are important in producing psychological change. In this study, we examine how these two forms of interaction relate to each other over time. We present results from a longitudinal ethnographic study of participation in an environmental campaign, documenting endurance and prevalence of psychological change. Participants, locals (n = 14) and self‐defined activists (n = 14), connected enduring psychological changes, such as changes in consumer behaviour and attitudes to their involvement in the environmental campaign. Thematic analysis of interviews suggested that participants linked the process of change to categorizing themselves in a new environmental‐activist way that influenced their everyday lives beyond the immediate campaign. This recategorization was a result of a conflictual intergroup relationship with the police. The intergroup interaction produced supportive within‐group relationships that facilitated the feasibility and sustainability of new world views that were maintained by staying active in the campaign. The data from the study support and extend previous research on collective action and are the basis of a model, suggesting that intragroup processes condition the effects of intergroup dynamics on sustained psychological change

Madagascar’s extraordinary biodiversity: Threats and opportunities

Madagascar's unique biota is heavily affected by human activity and is under intense threat. Here, we review the current state of knowledge on the conservation status of Madagascar's terrestrial and freshwater biodiversity by presenting data and analyses on documented and predicted species-level conservation statuses, the most prevalent and relevant threats, ex situ collections and programs, and the coverage and comprehensiveness of protected areas. The existing terrestrial protected area network in Madagascar covers 10.4% of its land area and includes at least part of the range of the majority of described native species of vertebrates with known distributions (97.1% of freshwater fishes, amphibians, reptiles, birds, and mammals combined) and plants (67.7%). The overall figures are higher for threatened species (97.7% of threatened vertebrates and 79.6% of threatened plants occurring within at least one protected area). International Union for Conservation of Nature (IUCN) Red List assessments and Bayesian neural network analyses for plants identify overexploitation of biological resources and unsustainable agriculture as themost prominent threats to biodiversity. We highlight five opportunities for action at multiple levels to ensure that conservation and ecological restoration objectives, programs, and activities take account of complex underlying and interacting factors and produce tangible benefits for the biodiversity and people of Madagascar