Radiology for medical students (1925-2018): an overview

Objective: Radiology has been espoused as an excellent tool for educating medical students since 1925. Advances in technology and PACS mean it has never been easier to demonstrate living anatomy and clinical pathology in exquisite detail to students. The aim of this study was to provide an overview of radiologic publications related to teaching medical students and its evolution through time. Methods: A literature search was performed from inception to November 2018. The search strategies used both text words and relevant indexing related to “radiology”, “medical students” and “curriculum”. Results: 3589 records were identified of which 377 were included. There was a 100 fold increase in rate of publication over time—most were expository or surveys (60%), with few truly experimental articles. Radiology was used in clinical teaching (67%) and anatomy (33%). Almost half of radiologic anatomy teaching was conducted without the input of a Radiologist. Compulsory clinical clerkships/blocks in radiology was offered infrequently (35%). Female first authorship had increased in the last decade (47%). Conclusion: There is a significant increase in articles published on the role of radiology in medical student teaching in the last decade. Research in this area is required in order to investigate the role of radiology in improving the modern medical students’ education

Radiology and the medical student: do increased hours of teaching translate to more radiologists?

Objectives: The UK has a shortage of Radiologists to meet the increasing demand for radiologic examinations. To encourage more medical students to consider Radiology as a career, increased exposure at undergraduate level has been advocated. The aim of this study was to evaluate if formal Radiology teaching hours at medical school had any association with the number of qualified Radiologists joining the General Medical Council Specialist Register. Methods: Total number of doctors joining the GMC Specialist Register as Clinical Radiologists, and those with a primary medical qualifications awarded in Scotland, was obtained from the GMC (2010–2020). Graduate numbers from all 4 Scottish Medical Schools (2000–2011) were also obtained. Hours of Radiology teaching for medical schools in Scotland were obtained from validated AToMS study. Results: Two hundred and twenty three (6.6%) of 3347 Radiologists added to the GMC Specialist Register between 2010 and 2020 received their primary medical qualification (PMQ) from Scottish Universities. The number of Radiologists from Scottish Universities joining the GMC specialist register was 2.6% of the total number of Scottish Medical Graduates. There was no association between the number of hours (Range 1–30) Radiology was taught to medical students and the number that joined the specialist register as Radiologists (p = 0.54 chi square trend). Conclusion: Increased exposure to Radiology teaching does not influence medical students’ decision to take up Radiology as a career. While continued Radiology exposure remains important, other strategies are required in both the short and long term to ensure radiology services are maintained without detriment to patients

Subcutaneous and visceral adipose tissue in patients with primary and recurrent incisional hernia

Purpose: Visceral obesity rather than body mass index has been reported to be associated with a higher incidence of incisional hernias. The aim of this study was to examine the relationship between CT measured adipose tissue and muscle in primary and recurrent incisional hernia. Methods: Patients with a ‘Primary’ or ‘Recurrent incisional hernia’ were obtained from a prospective cohort of patients who were being assessed for incisional hernia repair over a 2-year period. Computerised tomography (CT)-images were analysed using NIH Image-J software to quantify adipose tissue and skeletal muscle cross-sectional areas at the level of lumber vertebra 3/4 using standard Hounsfield units. To test inter-observer ‘absolute agreement’, each parameter was measured independently by two investigators and reliability analysis performed. Results: Thirty-six patients were included in the study: 15 had a Primary while 21 had a Recurrent incisional hernia. Both groups had similar baseline characteristics. Reliability analysis for CT-measured areas showed very high interclass correlation coefficient (ICC) between observers. Patients in the recurrent group had significantly greater subcutaneous adipose tissue (SAT) [median = 321.9cm2 vs 230.9cm2, p = 0.04] and visceral adipose tissue (VAT) [median = 221.1cm2 vs 146.8cm2, p = 0.03] than those in the primary group. There was no difference in skeletal muscle areas for right [median = 2.8cm2 vs 2.9cm2] and left [median = 3.7cm2 vs 4.1cm2] rectus muscles between groups. Conclusion: Our study shows that patients with a recurrent incisional hernia have significantly more subcutaneous and visceral adipose tissue than those with a primary incisional hernia. Further studies in this area are required if we are to reduce the burden of recurrent hernia following repair of a primary incisional hernia

Medical student assessments-frequency of radiological images used : a national study

Assessments are a key part of life for medical students at University. We know there is variation in these assessments across Universities. The aims of this study were to expatiate summative assessments in Scottish Medical Schools and to examine how frequently radiological images feature in them. All Scottish medical schools were invited to participate in the study. Data on objective structured clinical examinations (OSCEs; 5 years) and written assessments (3 years) were retrospectively collected for each university and results were collated. Each University was randomly assigned a letter from A to E and anonymised for data presentation. 10,534 multiple choice questions (MCQ) and 1083 OSCE stations were included in this study. There was wide variation in the number, type and timing of assessments across Scottish medical schools. There were highly significant differences in the number of OSCE stations and the number of MCQs set over the study period ( <0.0001). Radiological images were used on average 0.6 times (range 0-1.1) in each OSCE examination and 2.4 times (range 0.1-3.7) for written assessments. In this detailed study, we demonstrated significant differences in medical student assessments across Scottish Universities. Given the importance of Radiology in modern medicine, the frequency and differences in which radiological images were used in assessments across Universities should be addressed. This is the first national longitudinal study to quantify the role of radiological images in summative Medical Student Assessments. Great variability exists in the extent and how (clinical versus written assessments) radiological images are used to assess Scottish medical students. Radiological images are used infrequently in clinical assessments, but are present in every written assessment. These findings could help inform medical schools and academic radiologists as they prepare medical students for the imminent unified medical licensing examination, where Clinical Imaging is a subject with one of the highest number of associated conditions examinable. [Abstract copyright: © 2020 The Authors. Published by the British Institute of Radiology.]Publisher PDFPeer reviewe

Applying computational predictions of biorelevant solubility ratio upon self-emulsifying lipid-based formulations dispersion to predict dose number

Computational approaches are increasingly utilised in development of bio-enabling formulations, including self-emulsifying drug delivery systems (SEDDS), facilitating early indicators of success. This study investigated if in silico predictions of drug solubility gain i.e. solubility ratios (SR), after dispersion of a SEDDS in biorelevant media could be predicted from drug properties. Apparent solubility upon dispersion of two SEDDS in FaSSIF was measured for 30 structurally diverse poorly water soluble drugs. Increased drug solubility upon SEDDS dispersion was observed in all cases, with higher SRs observed for cationic and neutral versus anionic drugs at pH 6.5. Molecular descriptors and solid-state properties were used as inputs during partial least squares (PLS) modelling resulting in predictive models for SRMC (r2 = 0.81) and SRLC (r2 = 0.77). Multiple linear regression (MLR) facilitated generation of simplified SR equations with high predictivity (SRMC r2 = 0.74; SRLC r2 = 0.69), requiring only three drug properties; partition coefficient at pH 6.5 (logD6.5), melting point (Tm) and aromatic bonds as fraction of total bonds (FArom_B). Through using the equations to inform drug developability classifications (DCS) for drugs that have already been licensed as lipid based formulations, merits for development with SEDDS was predicted for 2/3 drugs

Mal-positioned nasogastric feeding tubes: are medical students safe to identify them?

Objectives: Nasogastric tube (NGT) placement is listed against Clinical Imaging in the upcoming Medical Licensing Assessment – compulsory for every graduating UK medical student from 2025. This study aims to establish the ability of medical students to correctly identify the position of an NGT on Chest Xray (CXR) and to evaluate a learning tool to improve student outcome in this area. Materials and Methods: Fourth (MB4) and Fifth-year (MB5) medical students were invited to view 20 CXRs with 14 correctly sited and 6 mal-positioned NGT. MB5 students (Intervention) were exposed to an online interactive learning tool, with MB4 students kept as control. One week later, both groups of students were invited to view 20 more CXRs for NGT placement. Results: Only 12 (4.8%) of 249 MB5 students and 5 (3.1%) of 161 MB4 students correctly identified all the NGTs on CXRs. The number of students misidentifying 1 or more mal-position NGT as “safe to feed” was 129 (51.8%) for MB5 and 76 (47.2%) for MB4 students. This improved significantly (p&lt;0.001) following exposure to the learning tool with 58% scoring all CXRs correctly while 28% scored 1 or more mal-positioned NGT incorrectly. Students struggled to determine if the NGT tip had adequately passed into the stomach. However, they failed to identify an NG tube in the lung (“Never event”) in just one out of 1,108 opportunities. Conclusion: Medical students’ ability to determine if the NGT was in the stomach remains suboptimal despite exposure to over 60 CXRs. Feeding NGT should be formally reported before use. Advances in Knowledge: This is the first attempt at quantifying graduating medical students’, and by inference junior doctors’, competence in safely identifying misplaced nasogastric feeding tubes. An online, experiential learning resource significantly improved their ability

Identification and manipulation of the pleuromutilin gene cluster from Clitopilus passeckerianus for increased rapid antibiotic production

Semi-synthetic derivatives of the tricyclic diterpene antibiotic pleuromutilin from the basidiomycete Clitopilus passeckerianus are important in combatting bacterial infections in human and veterinary medicine. These compounds belong to the only new class of antibiotics for human applications, with novel mode of action and lack of cross-resistance, representing a class with great potential. Basidiomycete fungi, being dikaryotic, are not generally amenable to strain improvement. We report identification of the seven-gene pleuromutilin gene cluster and verify that using various targeted approaches aimed at increasing antibiotic production in C. passeckerianus, no improvement in yield was achieved. The seven-gene pleuromutilin cluster was reconstructed within Aspergillus oryzae giving production of pleuromutilin in an ascomycete, with a significant increase (2106%) in production. This is the first gene cluster from a basidiomycete to be successfully expressed in an ascomycete, and paves the way for the exploitation of a metabolically rich but traditionally overlooked group of fungi

Rejuvenated brewer's spent grain: the impact of two BSG-derived ingredients on techno-functional and nutritional characteristics of fibre-enriched pasta

Brewer's Spent Grain (BSG), rich in fibre and protein is mostly used for animal feed but has great potential to be used as an ingredient for cereal based products. Originated from BSG, the two ingredients EverVita Fibra (EVF) high in fibre; and EverVita Pro (EVP) high in protein, were used to produce fibre-enriched pasta and compared to semolina, wholemeal flour and a commercial fibre-rich pasta. Analysis of gluten network development and pasting properties revealed the formation of a stronger network by the incorporation of EVP resulting in a compact pasta structure which led to a higher pasta firmness and tensile strength and a decrease in predicted glycaemic index compared to the controls. EVF resulted in an inferior product compared to EVP but was comparable to the semolina control. Hence, EVF and EVP have the potential to increase nutritional value of pasta while maintaining or even improving pasta quality and encouraging the recycling of by-streams for food production

An Analysis of the Cost of the Abatement of Ammonia Emissions in Irish Agriculture to 2030

peer-reviewedThis analysis quantifies the potential to abate national ammonia (NH3) emissions up to 2030. This report is an updated marginal abatement cost curve (MACC) analysis where Teagasc has quantified the abatement potential of a range of ammonia mitigation measures, as well as their associated costs/benefits (see Lanigan et al. 2015 for previous analysis). The objective of this analysis is to quantify the extent and costs associated with meeting future ammonia emission targets that were negotiated as part of the amended Clean Air Policy Package. The requirement to reduce ammonia emissions is urgent, both in terms of compliance with the National Emissions Ceilings Directive (NECD), and as a principal loss pathway for agricultural nitrogen (N). Improvement of N efficiency is a key focus for improving farm efficiency and sustainability as well as reducing the ammonia, nitrate and greenhouse gas (GHG) footprint of agriculture. This is particularly relevant in the context of the national strategies on the development of the agri-food sector: Food Wise 2025, Ag-food strategy 2030 and Ag-Climatise (currently under development) and the newly unveiled EU Farm to Fork Strategy, which is a part of the European Green Deal. Under the baseline scenario (S1), agricultural ammonia emissions are projected to increase by 9% (without any mitigation) by 2030 relative to 2005 levels. While these increases are small in comparison to the targeted increase in agricultural output, they will provide a major challenge to meeting emissions targets, particularly as agriculture comprises over 99% of national emissions. The analysis presented in this report seeks to quantify the ammonia mitigation potential under likely uptake pathways. This is not an exhaustive analysis of all mitigation measures, but represents an assessment of best available techniques, based on scientific, peer-reviewed research carried out by Teagasc and associated national and international research partners. Indeed, any future changes in the sector or in the national emission inventory calculations will require further analysis of the applicability of ammonia mitigation techniques, particularly in terms of housing and storage but also in the context of other reactive N1 emissions. It should also be noted that some mitigation measures, particularly those related to nitrogen application to soils, could result in either higher greenhouse gas emissions or higher nitrate leaching. Compared to a future where no mitigation measures are deployed to address emissions, by 2030 the average technical abatement2 potential was estimated to be approximately 15.26 kt NH3 at a net cost of €10.86 million per annum. However, it should be noted that the net cost (€10.86 million) is comprised of 6 measures that are cost negative (-€22.21 million) and 7 measures that are cost positive (€33.07) and that some of the cost negative measures are predicated on efficiency gains driven by best management practice adoption (e.g. liming and clover measures with associate chemical N reductions). Amongst the thirteen mitigation measures selected for this analysis, 80% of the mitigation potential can be achieved by the full implementation of the mitigation pathways for protected urea and low emission slurry spreading (LESS) techniques for bovines. It should be stressed that this is an assessment of the maximum abatement potential and realising this level of abatement in practice will be extremely challenging. Any increase in agricultural activity beyond the baseline scenario will increase absolute emissions. The level of mitigation achievable is based on the draft AgClimatise measures any delay or reduction in the uptake of these measures will reduce the mitigation achieved. It must also be ensured that all mitigation measures should, where possible, be synergistic with reductions in greenhouse gas emissions and N loss to water

Effects of laparoscopy on intraperitoneal tumor growth and distant metastases in an animal model

Background and aims: Laparoscopic surgery for colorectal cancer is currently being evaluated in humans. The aim of this study was to examine the effect of laparoscopy on intraperitoneal tumor growth and distant metastases in an animal model. We also examined the effect of combining laparotomy with laparoscopy and on infusing the peritoneal cavity with normal saline solution (NaCl), water, and sodium hypochlorite after laparoscopy on intraperitoneal tumor growth. Material and methods: Female Fischer rats were given MtLn3 adenocarcinoma cells by intraperitoneal injection to produce intraperitoneal tumor growth and by tail vein injection to produce lung metastases. A pneumoperitoneum was then induced to a pressure of 8 mm Hg with carbon dioxide (CO2), helium, or room air. After this, animals were allowed to either recover or underwent laparotomy or infusion of NaCl, water, or sodium hypochlorite before recovery, depending on the experiment. At 21 days all animals were killed and intraperitoneal tumor growth was assessed by counting the number of peritoneal and serosal nodules and by weighing the omental pad of tumor. Lung metastases were assessed by counting the number of metastases after fixation. Results: Laparoscopy caused a marked intraperitoneal dissemination of tumor with a median of 17 (10 to 20) peritoneal and serosal nodules for CO2, 19.5 (12.5 to 25) for helium, and 15.0 (9.5 to 17.7) for room air compared with 0 (0 to 1) for controls (P &#60;.0001). The weight of omental tumor was also significantly increased (P &#60;.02) in the CO2, helium, and room air groups. Infusion with NaCl, water, or sodium hypochlorite had no effect on tumor dissemination after laparoscopy. The combination of laparoscopy and laparotomy caused a significant reduction (P &#60;.05) in the number of peritoneal nodules but had no significant effect on omental tumor growth. Laparoscopy also had no effect on the number of pulmonary metastases induced compared with controls. Conclusions: This study shows that laparoscopy promotes intraperitoneal dissemination of tumor. This effect is independent of the insufflating gas used and is not affected by use of a cytotoxic agent. The use of gasless laparoscopy should be encouraged by those undertaking curative laparoscopic surgery for colorectal cancer