Perceptions of final-year UKZN medical students about anaesthesia as a specialty choice

Background: South Africa suffers from a drastic shortage of anaesthesiologists. This shortage has a major impact on the provision of safe, timeous and appropriate surgery for the population. One factor implicated in this shortage may be the difficulty in appropriate recruitment of trainees.Methods: A questionnaire-based cross-sectional study was conducted among the final-year medical students at the University of KwaZulu-Natal (UKZN), for the year 2013.Results: At total of 112 final-year medical students participated in the study. The majority (93%) of the medical students would like to specialise in the future. Anaesthesiology ranked fourth in popularity among the specialties presented to the students. The students’ opinion of the key positive attributes of anaesthesiology was that it was interesting (26.8%), mentally challenging (22.3%) and afforded good working hours (18.8%). The key negative attributes of anaesthesiology highlighted by the students were that it was boring (21.4%), stressful (20.5%) and frightening (15.2%). The biggest influence on the medical students’ perceptions of anaesthesiology was the medical school rotation, with the need for longer duration of exposure, highlighted by 24 (21.4%) of the students.Conclusion: The perceptions of medical students concerning anaesthesia are multi-faceted, with the undergraduate anaesthetic rotation viewed as the biggest influence on their perceptions regarding anaesthesia. All anaesthetists should strive to improve the discipline profile, change the misconceptions and enhance the attractiveness of the specialty amongst medical students from foundation level upwards.Keywords: anaesthesia, education, medical students, perceptions, workforce shortag

An investigation of the impact of wind speed and turbulence on small wind turbine operation and fatigue loads

This paper investigates the operation and loading of a 5 kW HAWT using the aeroelastic code FAST. Wind data from built environment site at Port Kennedy (PK) and from a flat terrain site in Östergarnsholm (OG), are analysed and compared with IEC 61400-2. The longitudinal turbulence intensity (TIu) in the PK wind field was 22%; which was higher than the estimated value in IEC 61400-2 Normal Turbulence Model. The TI in the flat terrain (OG) was below 18% for all mean wind speeds. The selected wind conditions from the two locations were used as input in FAST simulation to investigate the performance and loading of the turbine. The elevated turbulence in PK wind fields increased the output rotor power which was more than that predicted by the standard. Similarly, PK wind field also showed higher blade root flapwise bending moment resulting into twice as much damage load on the turbine blades due to large short-term fluctuations in both wind speed and direction. This value for OG was below the standard's prediction. We observe that the current IEC standard seems inadequate for urban siting of SWTs and requires modification for more reliable deployment in turbulent sites

A single administration of combination therapy inhibits breast tumour progression in bone and modifies both osteoblasts and osteoclasts

We have previously shown that repeated sequential administration of doxorubicin, followed 24 h later by zoledronic acid, inhibits tumour growth in models of established breast cancer bone metastasis. As breast cancer patients only receive zoledronic acid every 3-4 weeks, the aim of the current study was to establish the anti-tumour and bone effects of a single administration of doxorubicin/zoledronic acid combination therapy in a bone metastasis model. MDA-MB-231-GFP cells were injected i.c. in 6-week-old nude mice. On day 2, animals received PBS, doxorubicin (2 mg/kg i.v.), zoledronic acid (100 μg/kg s.c.) or doxorubicin followed 24 h later by zoledronic acid. Anti-tumour effects were assessed on days 15/23 by quantification of apoptotic and proliferating cells and changes in expression of genes implicated in apoptosis, proliferation and bone turnover. Bone effects were assessed by μCT analysis, bone histomorphometry and measurement of serum markers. A tumour-free control group was included. Combination treatment reduced bone tumour burden compared to single agent or PBS control and increased levels of tumour cell apoptosis on day 15, but this was no longer detectable on day 23. Animals receiving zoledronic acid had increased bone density, without evidence of tumour-induced lesions. Bone histomorphometry showed that zoledronic acid caused a decrease in osteoblast and osteoclast numbers and an increase in osteoclast size, in both tumour-free and tumour-bearing animals. Our data show that although zoledronic acid modifies the bone microenvironment through effects on both osteoblasts and osteoclasts, this does not result in a significant anti-tumour effect in the absence of doxorubicin. © 2012 Elsevier GmbH. All rights reserved

Human breast cancer bone metastasis in vitro and in vivo: a novel 3D model system for studies of tumour cell-bone cell interactions.

Bone is established as the preferred site of breast cancer metastasis. However, the precise mechanisms responsible for this preference remain unidentified. In order to improve outcome for patients with advanced breast cancer and skeletal involvement, we need to better understand how this process is initiated and regulated. As bone metastasis cannot be easily studied in patients, researchers have to date mainly relied on in vivo xenograft models. A major limitation of these is that they do not contain a human bone microenvironment, increasingly considered to be an important component of metastases. In order to address this shortcoming, we have developed a novel humanised bone model, where 1 × 10(5) luciferase-expressing MDA-MB-231 or T47D human breast tumour cells are seeded on viable human subchaodral bone discs in vitro. These discs contain functional osteoclasts 2-weeks after in vitro culture and positive staining for calcine 1-week after culture demonstrating active bone resorption/formation. In vitro inoculation of MDA-MB-231 or T47D cells colonised human bone cores and remained viable for <4 weeks, however, use of matrigel to enhance adhesion or a moving platform to increase diffusion of nutrients provided no additional advantage. Following colonisation by the tumour cells, bone discs pre-seeded with MDA-MB-231 cells were implanted subcutaneously into NOD SCID mice, and tumour growth monitored using in vivo imaging for up to 6 weeks. Tumour growth progressed in human bone discs in 80 % of the animals mimicking the later stages of human bone metastasis. Immunohistochemical and PCR analysis revealed that growing MDA-MB-231 cells in human bone resulted in these cells acquiring a molecular phenotype previously associated with breast cancer bone metastases. MDA-MB-231 cells grown in human bone discs showed increased expression of IL-1B, HRAS and MMP9 and decreased expression of S100A4, whereas, DKK2 and FN1 were unaltered compared with the same cells grown in mammary fat pads of mice not implanted with human bone discs

Oestrogen receptor positive breast cancer metastasis to bone: inhibition by targeting the bone microenvironment in vivo

Clinical trials have shown that adjuvant Zoledronic acid (ZOL) reduces the development of bone metastases irrespective of ER status. However, post-menopausal patients show anti-tumour benefit with ZOL whereas pre-menopausal patients do not. Here we have developed in vivo models of spontaneous ER+ve breast cancer metastasis to bone and investigated the effects of ZOL and oestrogen on tumour cell dissemination and growth. ER+ve (MCF7, T47D) or ER−ve (MDA-MB-231) cells were administered by inter-mammary or inter-cardiac injection into female nude mice ± estradiol. Mice were administered saline or 100 μg/kg ZOL weekly. Tumour growth, dissemination of tumour cells in blood, bone and bone turnover were monitored by luciferase imaging, histology, flow cytometry, two-photon microscopy, micro-CT and TRAP/P1NP ELISA. Estradiol induced metastasis of ER+ve cells to bone in 80–100 % of animals whereas bone metastases from ER−ve cells were unaffected. Administration of ZOL had no effect on tumour growth in the fat pad but significantly inhibited dissemination of ER+ve tumour cells to bone and frequency of bone metastasis. Estradiol and ZOL increased bone volume via different mechanisms: Estradiol increased activity of bone forming osteoblasts whereas administration of ZOL to estradiol supplemented mice decreased osteoclast activity and returned osteoblast activity to levels comparable to that of saline treated mice. ER−ve cells require increased osteoclast activity to grow in bone whereas ER+ve cells do not. Zol does not affect ER+ve tumour growth in soft tissue, however, inhibition of bone turnover by ZOL reduced dissemination and growth of ER+ve breast cancer cells in bone

The suitability of the IEC 61400-2 wind model for small wind turbines operating in the built environment

This paper investigates the applicability of the assumed wind fields in International Electrotechnical Commission (IEC) standard 61400 Part 2, the design standard for small wind turbines, for a turbine operating in the built environment, and the effects these wind fields have on the predicted performance of a 5 kW Aerogenesis turbine using detailed aeroelastic models developed in Fatigue Aerodynamics Structures and Turbulence (FAST). Detailed wind measurements were acquired at two built environment sites: from the rooftop of a Bunnings Ltd. warehouse at Port Kennedy (PK) (Perth, Australia) and from the small wind turbine site at the University of Newcastle at Callaghan (Newcastle, Australia). For both sites, IEC 61400-2 underestimates the turbulence intensity for the majority of the measured wind speeds. A detailed aeroelastic model was built in FAST using the assumed wind field from IEC 61400-2 and the measured wind fields from PK and Callaghan as an input to predict key turbine performance parameters. The results of this analysis show a modest increase in the predicted mean power for the higher turbulence regimes of PK and Callaghan as well as higher variation in output power. Predicted mean rotor thrust and blade flapwise loading showed a minor increase due to higher turbulence, with mean predicted torque almost identical but with increased variations due to higher turbulence. Damage equivalent loading for the blade flapwise moment was predicted to be 58% and 11% higher for a turbine operating at Callaghan and PK respectively, when compared with IEC 61400-2 wind field. Time series plots for blade flapwise moments and power spectral density plots in the frequency domain show consistently higher blade flapwise bending moments for the Callaghan site with both the sites showing a once-per-revolution response

Characterization and temperature dependence of Arctic Micromonas polaris viruses

Global climate change-induced warming of the Artic seas is predicted to shift the phytoplankton community towards dominance of smaller-sized species due to global warming. Yet, little is known about their viral mortality agents despite the ecological importance of viruses regulating phytoplankton host dynamics and diversity. Here we report the isolation and basic characterization of four prasinoviruses infectious to the common Arctic picophytoplankter Micromonas. We furthermore assessed how temperature influenced viral infectivity and production. Phylogenetic analysis indicated that the putative double-stranded DNA (dsDNA) Micromonas polaris viruses (MpoVs) are prasinoviruses (Phycodnaviridae) of approximately 120 nm in particle size. One MpoV showed intrinsic differences to the other three viruses, i.e., larger genome size (205 ± 2 vs. 191 ± 3 Kb), broader host range, and longer latent period (39 vs. 18 h). Temperature increase shortened the latent periods (up to 50%), increased the burst size (up to 40%), and affected viral infectivity. However, the variability in response to temperature was high for the different viruses and host strains assessed, likely affecting the Arctic picoeukaryote community structure both in the short term (seasonal cycles) and long term (global warming)

Fluctuation Theorems for Entropy Production and Heat Dissipation in Periodically Driven Markov Chains

Asymptotic fluctuation theorems are statements of a Gallavotti-Cohen symmetry in the rate function of either the time-averaged entropy production or heat dissipation of a process. Such theorems have been proved for various general classes of continuous-time deterministic and stochastic processes, but always under the assumption that the forces driving the system are time independent, and often relying on the existence of a limiting ergodic distribution. In this paper we extend the asymptotic fluctuation theorem for the first time to inhomogeneous continuous-time processes without a stationary distribution, considering specifically a finite state Markov chain driven by periodic transition rates. We find that for both entropy production and heat dissipation, the usual Gallavotti-Cohen symmetry of the rate function is generalized to an analogous relation between the rate functions of the original process and its corresponding backward process, in which the trajectory and the driving protocol have been time-reversed. The effect is that spontaneous positive fluctuations in the long time average of each quantity in the forward process are exponentially more likely than spontaneous negative fluctuations in the backward process, and vice-versa, revealing that the distributions of fluctuations in universes in which time moves forward and backward are related. As an additional result, the asymptotic time-averaged entropy production is obtained as the integral of a periodic entropy production rate that generalizes the constant rate pertaining to homogeneous dynamics