The learner’s perspective in GP teaching practices with multi-level learners: a qualitative study

BACKGROUND Medical students, junior hospital doctors on rotation and general practice (GP) registrars are undertaking their training in clinical general practices in increasing numbers in Australia. Some practices have four levels of learner. This study aimed to explore how multi-level teaching (also called vertical integration of GP education and training) is occurring in clinical general practice and the impact of such teaching on the learner. METHODS A qualitative research methodology was used with face-to-face, semi-structured interviews of medical students, junior hospital doctors, GP registrars and GP teachers in eight training practices in the region that taught all levels of learners. Interviews were audio-recorded and transcribed. Qualitative analysis was conducted using thematic analysis techniques aided by the use of the software package N-Vivo 9. Primary themes were identified and categorised by the co-investigators. RESULTS 52 interviews were completed and analysed. Themes were identified relating to both the practice learning environment and teaching methods used.A practice environment where there is a strong teaching culture, enjoyment of learning, and flexible learning methods, as well as learning spaces and organised teaching arrangements, all contribute to positive learning from a learners' perspective.Learners identified a number of innovative teaching methods and viewed them as positive. These included multi-level learner group tutorials in the practice, being taught by a team of teachers, including GP registrars and other health professionals, and access to a supernumerary GP supervisor (also termed "GP consultant teacher"). Other teaching methods that were viewed positively were parallel consulting, informal learning and rural hospital context integrated learning. CONCLUSIONS Vertical integration of GP education and training generally impacted positively on all levels of learner. This research has provided further evidence about the learning culture, structures and teaching processes that have a positive impact on learners in the clinical general practice setting where there are multiple levels of learners. It has also identified some innovative teaching methods that will need further examination. The findings reinforce the importance of the environment for learning and learner centred approaches and will be important for training organisations developing vertically integrated practices and in their training of GP teachers.This project was supported by a grant from General Practice Education and Training through Coast City Country General Practice Training. This project was approved for conduct by the ANU Human Research Ethics Committee (protocol number 2011/415)

Rupture and Migration of an Endovascular Stent in the Brachiocephalic Trunk Causing a Vertebral Steal Syndrome

Delayed stent fracture has been observed in many different arteries and may represent a risk factor for restenosis. We describe the case of a delayed rupture of an endovascular brachiocephalic trunk stent. The complete fracture allowed a fragment to migrate distally and tilt, resulting in a hemodynamic pattern similar to that of a prevertebral stenosis with complete inversion of the homolateral vertebral blood flow. The induced vertebral steal syndrome as well as the risk of cerebral embolism was corrected by an aortobrachiocephalic bypass and resection of the ruptured sten

Status Report on Education in the Economics of Animal Health: Results from a European Survey

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Human Wharton’s jelly mesenchymal stromal cell-derived small extracellular vesicles drive oligodendroglial maturation by restraining MAPK/ERK and Notch signaling pathways.

Peripartum cerebral hypoxia and ischemia, and intrauterine infection and inflammation, are detrimental for the precursor cells of the myelin-forming oligodendrocytes in the prematurely newborn, potentially leading to white matter injury (WMI) with long-term neurodevelopmental sequelae. Previous data show that hypomyelination observed in WMI is caused by arrested oligodendroglial maturation rather than oligodendrocyte-specific cell death. In a rat model of premature WMI, we have recently shown that small extracellular vesicles (sEV) derived from Wharton's jelly mesenchymal stromal cells (WJ-MSC) protect from myelination deficits. Thus, we hypothesized that sEV derived from WJ-MSC directly promote oligodendroglial maturation in oligodendrocyte precursor cells. To test this assumption, sEV were isolated from culture supernatants of human WJ-MSC by ultracentrifugation and co-cultured with the human immortalized oligodendrocyte precursor cell line MO3.13. As many regulatory functions in WMI have been ascribed to microRNA (miR) and as sEV are carriers of functional miR which can be delivered to target cells, we characterized and quantified the miR content of WJ-MSC-derived sEV by next-generation sequencing. We found that WJ-MSC-derived sEV co-localized with MO3.13 cells within 4 h. After 5 days of co-culture, the expression of myelin basic protein (MBP), a marker for mature oligodendrocytes, was significantly increased, while the oligodendrocyte precursor marker platelet-derived growth factor alpha (PDGFRα) was decreased. Notch and MAPK/ERK pathways known to inhibit oligodendrocyte maturation and differentiation were significantly reduced. The pathway enrichment analysis showed that the miR present in WJ-MSC-derived sEV target genes having key roles in the MAPK pathway. Our data strongly suggest that sEV from WJ-MSC directly drive the maturation of oligodendrocyte precursor cells by repressing Notch and MAPK/ERK signaling

Integrating agriculture and health research for development: LCIRAH as an interdisciplinary programme to address a global challenge

The multiple burdens of persistent undernutrition and micronutrient deficiencies, along with the rapidly growing rates of overweight, obesity, and associated chronic diseases, are major challenges globally. The role of agriculture and the food system in meeting these challenges is very poorly understood. Achieving food security and addressing malnutrition in all its forms, a Sustainable Development Goal, requires an understanding of how changing food systems affect health outcomes and the development of new tools to design and evaluate interventions. An interinstitutional programme to address this interdisciplinary research challenge is described. Over the past seven years, the Leverhulme Centre for Integrative Research on Agriculture and Health has built a portfolio of successful and innovative research, trained a new cadre of interdisciplinary researchers in “Agri‐Health,” and built an international research community with a particular focus on strengthening research capacity in low‐ and middle‐income countries. The evolution of this programme is described, and key factors contributing to its success are discussed that may be of general value in designing interdisciplinary research programmes directed at supporting global development goals

Europe Needs Consistent Teaching of the Economics of Animal Health

The prevalence of meat consumption dictates that there is a global need for people educated in animal health economics. Since there are limited resources available for animal health surveillance, as well as the control and prevention of diseases, people skilled in animal health science with a deep understanding of economics and the allocation of scarce resources are required to enable consumer to access safe, value-added meat product

Rapid integrated assessment of food safety and nutrition related to pork consumption of regular consumers and mothers with young children in Vietnam

Pork is the most common and widely consumed meat product in Vietnam. The study aimed to assess nutrition and food safety risks and opportunities associated with pork value chains in Vietnam. Twenty-nine focus group discussions (FGD) were conducted in Hung Yen and Nghe An provinces with 164 participants who were both regular pork consumers and mothers with young children. In each province, three districts were selected, and in each district we selected one commune. To assess the quality of pork, we took 30 swab samples of pig carcasses at slaughterhouses, 90 pork samples at slaughterhouses and markets and analysed all samples for total bacterial count (TBC), coliforms, water holding capacity and pH. The results showed that pork was the main livestock product consumed and women are responsible for buying and preparing food for daily meals. Pork was the main animal sourced food (ASF) for Vietnamese consumers, for 50–60% of ASF. There was little knowledge of zoonotic diseases. The findings suggest further studies to address consumers’ concern on chemical contamination. Most market pork samples were not within the allowable range of limits standards of Vietnam for bacterial contamination: 90% of samples were above the official permissible limit for TBC and 98% did not meet standards for coliforms. Fifty percent of samples had acceptable pH but only 5% had acceptable water holding capacity. There were no significant differences in pork quality between intensifying Hung Yen and traditional Nghe An provinces, although there was a tendency for samples from Hung Yen to have better compliance. This rapid assessment revealed considerable interest and knowledge on pork nutrition and safety and found some behavioural but few quality and safety differences between traditional and intensifying systems. This indicated marketed pork is of low quality and safety, and a lack of support to consumers in making good choices

Neuropixels 2.0: A miniaturized high-density probe for stable, long-term brain recordings

Measuring the dynamics of neural processing across time scales requires following the spiking of thousands of individual neurons over milliseconds and months. To address this need, we introduce the Neuropixels 2.0 probe together with newly designed analysis algorithms. The probe has more than 5000 sites and is miniaturized to facilitate chronic implants in small mammals and recording during unrestrained behavior. High-quality recordings over long time scales were reliably obtained in mice and rats in six laboratories. Improved site density and arrangement combined with newly created data processing methods enable automatic post hoc correction for brain movements, allowing recording from the same neurons for more than 2 months. These probes and algorithms enable stable recordings from thousands of sites during free behavior, even in small animals such as mice