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Empathy is critical to the development of professionalism in medical students, but evidence suggests that empathy actually declines over the course of undergraduate medical education.
Improving medical student empathy by encouraging students to think about the person behind the illness.
Two interventions were studied. From December 2015 until November 2016, a fourth year psychiatry medical student book club was conducted. Students were asked to read an autobiography of a lived experience of psychosis. The old age simulation suit aims to simulate the sensory and physical impairments faced by older adults with age related illnesses. A training session provided a transient experience of old age for the students.
Forty-four students completed the feedback on the book club. Twenty-eight (64%) stated that they strongly agreed with the statement ‘the book club encouraged me to consider the person behind the illness’. Thirty-nine (89%) stated that after attending the book club their empathy towards people with mental health problems had increased. Eleven students completed full feedback following the old age simulation session. Empathy statements relating to living in an ageing body improved from the pre-test median score of 4 (range 1–7) to a median score of 6 (range 2–8) post-teaching session. Empathy statements focusing on sensory and physical impairments had pre-test score median of 3 (range 1–7) and post-test median 8 (range 3–9).
Feedback from these sessions has demonstrated that with a little creativity, empathy training can be delivered to medical students with a positive impact.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
North East London NHS Foundation Trust (NELFT) provides an extensive range of integrated community and mental health services for people living in London serving a population of 1.5 million people. With an annual budget of £325 million NELFT is one of the largest community service providers in the United Kingdom (UK). NELFT is responsible for the education and training of the entire workforce and in August 2016, it employed a nurse fellow to work with the medical education fellows so it could focus on multidisciplinary team (MDT) teaching.
(1) Providing MDT teaching by delivered by a MDT medical education team.
(2) Improving the training experience of all trainees, nurses and allied health professionals in NELFT.
(3) Improving physical health knowledge for mental health staff.
(4) Improving mental health knowledge of physical health staff.
Two psychiatrists and one nurse manager worked together on joint projects to deliver the MDT teaching. Teaching sessions where at least one psychiatrist and nurse manager delivered teaching on serious incidents affecting patient care, identification and management of sepsis in community settings and empathy training using an old age simulation suit.
Multiple teaching sessions were delivered to MDTs within the Trust. Staffs were receptive to learning in MDTs rather than traditional splits according to professions. Due to the success of this teaching and the reputation of the medical education team, neighboring Trusts have expressed an interest in working in partnership with the team to further enhance teaching and learning in acute and community settings.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Role-playing scenarios are widely used in psychiatry education, both as a means of assessment and for teaching various clinical skills. But can you get as much from them by learning vicariously as an observer? Fourth-year medical students from Queen Mary University of London were invited to a psychiatry practice OSCE (objective structured clinical examination), shortly before end of year exams. We created 96 places, approximately 40% of the year, but to maximize numbers students also rotated through the six-station OSCE circuit in pairs. For each scenario students alternated either undertaking the OSCE task or observing.
Objectives and methods
We sought to identify if there was a significant difference in student experience depending on whether they were the ‘candidate’ or ‘observer’. Students were asked to rate their learning experience in each station on a five-point Likert scale and this was analyzed using an ordinal logistic regression model.
While students rated their experiences as ‘observers’ marginally lower than that of ‘candidates’, we found no statistically significant difference (OR = 0.629, P = 0.093). Practice OSCEs took place over six half-days with different facilitators and role-players, but we identified no interaction from these factors. For one station on depression, we found a statistically significant interaction in which ‘candidates’ rather than ‘observers’ rated better experiences (P = 0.032).
Observation by learners is frequently used within simulated clinical scenarios and may have a number of potential advantages. However, while unable to examine the direct impact on knowledge or skills, we found no significant difference in student-reported experiences between ‘candidate’ and ‘observer’ positions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Calving is a complex process subject to several cooperating atmospheric, oceanographic and glaciological forcings that vary in space and time, and whose relative effects are challenging to separate. Statistical ‘Systems Analysis’ is commonly used in engineering and economics to extricate complex ‘force–response’ relationships. Here we apply Systems Analysis to the Amery rift system, East Antarctica. We develop a scalable ‘System Model’ driven by a coarsely-sampled dataset characteristic of glaciological observations in remote locations, and validate it using rift lengths observed in 2000–06 and 2012. In this initial demonstration, we forecast a detachment date of ~2019 ± 5 years for the large tabular iceberg colloquially known as the ‘Loose Tooth’, for which relative humidity surprisingly emerges as the best statistical predictor. RACMO2 climate modelling reveals that relative humidity correlates best with surface albedo and snowmelt, both of which are intimately linked to firn compaction and ice shelf temperature and flow. We postulate that relative humidity can therefore serve as a proxy for internal stress, a known key control of ‘Loose Tooth’ calving. Although no physical causality is implied in Systems Analysis, postulates such as this can aid in setting priorities in studies of complex glaciological processes.
In his study of Romantic music, Alfred Einstein suggested that the nineteenth century was no longer “a period of great choral music.” He based that judgment on his belief that the large-scale choral works written in that century presented nothing new, only a continuation of genres (mass, oratorio, requiem, motet, etc.) already well established in the preceding century. He dismissed the nineteenth century' s singular contribution to choral repertory – the part-song – as mere musical trifles designed to engage and entertain a new class of amateur singers. While there is an element of truth in Einstein's assessment, he failed to consider the new political, economic, and social realities to which composers of the time were responding. In this chapter, I shall (all too briefly) consider how the new cosmology of the nineteenth century transformed the nature of choirs and the music they sang.
Collision of cosmologies
While 1800 is a handy chronological marker, it is not particularly useful when defining cultural history. To understand nineteenth-century music, we must first understand the ideas of the preceding century that shaped it. The philosophical engine that fueled Europe's growth in the eighteenth century was the Enlightenment, a period dominated by scientific method and reason that postulated that, given sufficient time and information, humanity could construct a new Eden. Correlative to this philosophical stance was the emergence of the Industrial Revolution (c.1750) that offered the ideal laboratory for implementing the theoretical formulations of such “enlightened” thinkers as René Descartes, John Locke, Isaac Newton and Jean-Jacques Rousseau. In the history of music (especially choral music), the Enlightenment found clearest expression in the ecclesiastical reforms (c.1780) enacted by Emperor Joseph II of Austria and his disciple Hieronymus Colloredo, who served as Archbishop of Salzburg during Mozart’s time there.
On tests of design fluency, an examinee draws as many different designs as possible in a specified time limit while avoiding repetition. The neuroanatomical substrates and diagnostic group differences of design fluency repetition errors and total correct scores were examined in 110 individuals diagnosed with dementia, 53 with mild cognitive impairment (MCI), and 37 neurologically healthy controls. The errors correlated significantly with volumes in the right and left orbitofrontal cortex (OFC), the right and left superior frontal gyrus, the right inferior frontal gyrus, and the right striatum, but did not correlate with volumes in any parietal or temporal lobe regions. Regression analyses indicated that the lateral OFC may be particularly crucial for preventing these errors, even after excluding patients with behavioral variant frontotemporal dementia (bvFTD) from the analysis. Total correct correlated more diffusely with volumes in the right and left frontal and parietal cortex, the right temporal cortex, and the right striatum and thalamus. Patients diagnosed with bvFTD made significantly more repetition errors than patients diagnosed with MCI, Alzheimer's disease, semantic dementia, progressive supranuclear palsy, or corticobasal syndrome. In contrast, total correct design scores did not differentiate the dementia patients. These results highlight the frontal-anatomic specificity of design fluency repetitions. In addition, the results indicate that the propensity to make these errors supports the diagnosis of bvFTD. (JINS, 2012, 18, 1–11)
The articles collected here bear witness to the continued and wide interest in England and its neighbours in the "long" thirteenth century. The volume includes papers on the high politics of the thirteenth century, international relations, the administrative and governmental structures of medieval England and aspects of the wider societal and political context of the period. A particular theme of the papers is Anglo-French political history, and especially the ways in which that relationship was reflected in the diplomatic and dynastic arrangements associated with the Treaty of Paris, the 750th anniversary of which fell during 2009, a fact celebrated in this collection of essays and the Paris conference at which the original papers were first delivered.
Contributors: Caroline Burt, Julie E. Kanter, Julia Barrow, Benjamin L. Wild, William Marx, Caroline Dunn, Adrian Jobson, Adrian R. Bell, Chris Brooks, Tony K. Moore, David A. Trotter, William Chester Jordan, Daniel Power, Florent Lenègre
In antibody-directed enzyme prodrug therapy (ADEPT), an antibody is used to target an enzyme to tumor. After tumor localization and deactivation or clearance of enzyme from blood and other normal tissue, a prodrug is given. The prodrug is converted into a toxic chemotherapeutic by the pretargeted enzyme at the tumor site (Figure 22.1). The ADEPT system, originally conceived in 1987, has a number of potential advantages over standard chemotherapy or the use of antibody-toxin conjugates. If a relatively nontoxic prodrug is used and there is no significant conversion of prodrug in nontarget organs, toxicity is restricted to the tumor site, allowing highly potent and specific treatments. Moreover, since one enzyme is able to turn over many prodrug molecules, the tumor essentially becomes a factory for generating its own means of destruction. Importantly, active drug can also diffuse to nearby cells, creating a local bystander effect where antigen negative cells and tumor-supportive stromal elements are destroyed.
ADEPT is a complex system that can be influenced by many components. These components, outlined inFigure 22.2, have been investigated by various workers over the last 2 decades and the results provide a platform of understanding for future applications of the treatment. Here we describe the progress of ADEPT since the first proofs-of-principle to recent advances in the clinic.
Field experiments were conducted to study the effects of oxadiazon and oxyfluorfen on weeds and Syrian marjoram (Origanum syriacum L.) in the central Jordan Valley during the period from 1998 to 2001. Results showed that weed competition with marjoram for the whole growing period resulted in almost complete crop failure. Oxyfluorfen and oxadiazon applied preplanting or postplanting to marjoram controlled weeds effectively, resulted in significant increase in marjoram shoot fresh and dry weight yields and in more branches per plant compared with the weed-infested control. High marjoram yield was obtained with oxyfluorfen applied at 0.72 kg ai/ha in preplanting treatment and with oxadiazon at 1.25 and 0.75 kg ai/ha in pre- and postplanting treatments, respectively. In preplanting treatment, 0.36 kg ai/ha of oxyfluorfen was highly selective, but 1.44 kg ai/ha reduced marjoram yield. Conflicting results were obtained with oxadiazon under the same treatments. In postplanting, oxyfluorfen at 0.24 and 0.96 kg ai/ha significantly increased marjoram yield over the weed-infested control. However, the highest shoot dry weight of marjoram was obtained at 0.96 kg ai/ha of this herbicide. In contrast, the low rate (0.38 kg ai/ha) of oxadiazon was highly selective and increased marjoram yield, but the herbicide failed to increase yield beyond the weed-infested control when the higher rate (1.5 kg ai/ha) was used. Results showed that both oxyfluorfen and oxadiazon herbicides were highly selective and effective for weed control in Syrian marjoram, providing normal rates of both are used, although high rates of the two herbicides were also selective and increased marjoram yield over the weed-infested control.
Several weed species have been reported to have allelopathic activities. However, most of these studies indicate the probable involvement of allelochemicals but are not conducted in field settings. In addition to their adverse effects on growth and yield of many crop species, many troublesome weeds such as mugwort and lantana influence biodiversity. More studies on the ecological, physiological, and molecular aspects of weed allelopathy should be conducted in order to better understand community structure and declining biodiversity.
The number of papers published on allelopathy was low until the 1970s but has accelerated rapidly in recent years. Alleged allelopathic activity has been suggested for numerous weed and crop species; however, many studies employed preliminary bioassays (leachates or extracts in the absence of soil). The importance of substratum and of abiotic and biotic stresses (nutrients, shade, herbides, plant diseases, herbivores), plant density, habitat, and climate has been realized in recent years. Laboratory bioassay, the first step to investigate probable involvement of allelopathy, should be designed to correspond to field conditions. Studies need to focus on the effects of (1) climatic, environmental, and habitat factors on allelopathic potential; (2) abiotic and biotic soil components on fate and biological activity of allelochemicals; and (3) allelochemicals on soil nutrient dynamics, microbial ecology, and other abiotic and biotic components. Recently, attempts to find crop cultivars with a competitive allelopathic edge have been made. Interaction of professionals from different disciplines is needed to understand the complexity of the ecosystem. The following are important topics for discussion: allelopathy and the transition to sustainable agriculture; physiological and biochemical studies; using transgenes to produce allelopathic crops; microbial allelochemicals and pathogens as weed biological agents; bioassays for allelopathy (problems and solutions); pollen allelopathy; and an ecological perspective of allelopathy.
How surfactants modify the characteristics of a spray liquid is now reasonably well understood. Beneficial effects are primarily associated with reduction in surface tension. However, the mechanisms whereby surfactants enhance the diffusion of herbicides across the plant cuticle are less clear. Generally, hydrophilic surfactants with a high hydrophile/lipophile balance (HLB) are most effective at enhancing penetration of herbicides with high water solubility, whereas lipophilic surfactants with a low HLB are most effective for enhancing uptake of herbicides with low water solubility. Both high- and low-HLB surfactants are absorbed into the cuticle, but current theory suggests different mechanisms are involved in enhancing diffusion of hydrophilic and lipophilic herbicides across the cuticle. Surfactants having a high HLB are absorbed into the cuticle and enhance the water-holding capacity (hydration state) of the cuticle. With increased cuticle hydration, the permeance of hydrophilic herbicides into the cuticle is increased, which increases the herbicide diffusion rate at a constant concentration gradient. Surfactants having a low HLB are absorbed into the cuticle and increase the fluidity of waxes, as measured by a small reduction in melting point. This increased fluidity increases the permeance of lipophilic herbicides in the cuticle, which, in turn, increases their diffusion rate at a set concentration gradient.
Adjuvant research contributes much to the knowledge and practice of weed science though the scientific process of systematically asking precise questions and subsequently making distinctions among alternative explanations. The purpose of adjuvant experimentation is to answer these questions and the purpose of associated papers and presentations is to communicate the new information. These purposes are self-evident, but are difficult to perfect. Some factors are particularly difficult for adjuvant researchers and require that researchers plan thoroughly from the formulation of the experimental question to final presentation of results. Adjuvant research requires both chemical and biological expertise that is traditionally separated in most organizations. Scientists from other disciplines or weed scientists not primarily concerned with adjuvants often direct adjuvant studies. This paper discusses mistakes that are commonly made in test design, interpretation, and presentation and suggests guidelines to improve the quality of adjuvant research.