To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Non-medical opioid use (NMOU) is a growing crisis. Cancer patients at elevated risk of NMOU (+risk) are frequently underdiagnosed. The aim of this paper was to develop a nomogram to predict the probability of +risk among cancer patients receiving outpatient supportive care consultation at a comprehensive cancer center.
3,588 consecutive patients referred to a supportive care clinic were reviewed. All patients had a diagnosis of cancer and were on opioids for pain. All patients were assessed using the Edmonton Symptom Assessment Scale (ESAS), Screener and Opioid Assessment for Patients with Pain (SOAPP-14), and CAGE-AID (Cut Down-Annoyed-Guilty-Eye Opener) questionnaires. “+risk” was defined as an SOAPP-14 score of ≥7. A nomogram was devised based on the risk factors determined by the multivariate logistic regression model to estimate the probability of +risk.
731/3,588 consults were +risk. +risk was significantly associated with gender, race, marital status, smoking status, depression, anxiety, financial distress, MEDD (morphine equivalent daily dose), and CAGE-AID score. The C-index was 0.8. A nomogram was developed and can be accessed at https://is.gd/soappnomogram. For example, for a male Hispanic patient, married, never smoked, with ESAS scores for depression = 3, anxiety = 3, financial distress = 7, a CAGE score of 0, and an MEDD score of 20, the total score is 9 + 9+0 + 0+6 + 10 + 23 + 0+1 = 58. A nomogram score of 58 indicates the probability of +risk of 0.1.
Significance of results
We established a practical nomogram to assess the +risk. The application of a nomogram based on routinely collected clinical data can help clinicians establish patients with +risk and positively impact care planning.
Children and adolescents make up one third of the world's population. Neuropsychiatric disorders are the most prevalent cause of health burden in this age group and are estimated to effect 10 to 20 per cent of children worldwide. Little is known about the prevalence of child psychiatric morbidities and associated risk factors in countries like Pakistan.
This is a prospective cross sectional study of 300 participants aged 6 to 18 years. Participants were recruited from a general psychiatric outpatient department over 12 weeks in Lahore, Pakistan. Information was collected on presenting complaints, possible risk factors and mental health disorders using the strengths and difficulties (SDQ) questionnaire.
Our preliminary results show that frequently reported presenting complaint were fits and alterations in consciousness (54%), disturbed behaviour (14%) and depressive symptoms (8.3%). The most frequent mental health disorder on SDQ was hyperactivity, followed by conduct. Emotional problems were least commonly reported. Male participants scored higher for conduct disorder. A history of epilepsy was reported by 35.3% of participants. Low socio economic status, low educational achievement and nuclear family setup were associated with higher rates of illness.
Our results show that fits and alterations in consciousness was the most frequently reported presenting complaint. Hyperactivity was most prevalent followed by conduct. The majority of child and adolescent patients attend general practitioners or general psychiatry out-patient departments. They are managed by practitioners who lack adequate training. Training these clinicians would help utilisation of limited resources.
It has been estimated that the global burden of suicide is a million deaths per year (WHO, 2014). Rates of self-harm in British South Asian (BSA) women are higher compared to their white counterparts. Limited evidence is available on effective preventative strategies and culturally sensitive interventions for these patients.
To understand common perceptions about self-harm, identify any barriers to accessing services and service improvement recommendations including appropriate interventions for BSA women.
To examine the views of health professionals on the culturally adapted problem solving therapy (C-MAP) in BSA women.
The design was a qualitative study using focus group discussion. This is part of a larger exploratory trial, to test a culturally adapted problem solving therapy (C-MAP) in British South Asian women who have a history of self-harm (Husain et al., 2011). Three focus groups were held with Asian lay members of the community, health professionals and service users. The data was analysed using a manual content analysis and indexing technique.
Results showed lack of identification of self-harm by health professionals. Common self-harm methods reported were serious overdoses, use of household chemicals, burning and cutting. Lack of trust in GP s was one common reason for non-disclosure of self-harm behaviour. Need for increased awareness, working along with local Imams, better cultural sensitivity among health professionals and non-judgmental support were some solutions offered to address these barriers.
The results of this study have provided insight into developing strategies to prevent and manage self-harm in British South Asian women.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Flexural and thermomechanical properties of the epoxy-based carbon fiber composites (CFCs) on addition of single and binary nanoparticles (nanoclay and graphene) have been investigated. It was found that nanoclay acts more effectively in increasing the stiffness of the CFCs, whereas graphene is more effective in achieving higher strength. Nanoclay-added samples exhibited highest flexural (64.5 GPa) and storage (25.3 GPa) modulus among all types. Graphene-added samples showed highest improvement (by 21%) in flexural strength and exhibited most stable thermomechanical properties with highest energy dissipation capability (3.1 GPa loss modulus) in flexural test and dynamic mechanical analysis (DMA), respectively. By contrast, addition of binary nanoparticles reduced the stiffness and significantly increased the strain to failure (42%) of the composites. Optical microscopy and scanning electron microscopy indicated that addition of nanoparticles significantly reduced delamination and matrix cracking of the CFCs because of strong interfacial bonding and toughened matrix, respectively.
Innovation Concept: Medical students often face challenges when entering clerkship. The abundance of teaching tools and online resources make it difficult for learners to navigate and apply knowledge in a clinical setting. Although valuable study aids exist across Emergency Medicine (EM) clerkship curriculums, a convenient resource tailored to junior learners for on-shift use is lacking. We created an academic resource with the intent of assessing student engagement with the handbook. Methods: Ottawa's Clerkship Guide to Emergency Medicine was developed using information from a commonly used EM textbook and relevant literature. After a comprehensive peer-review by staff EM physicians, the resource was published online and made available to learners in March 2018. To assess utility of this resource, a national survey was administered followed by a Likert-type analysis. Website metrics and the survey results were used to guide a sustainable model for annual student-driven resource updates. Curriculum, Tool or Material: The handbook contains high-yield EM topics organized into one-page summaries. The main sections include resuscitation, symptoms-based approach, and medical emergencies. Students can access the handbook online, via mobile app, or use a printable version. Over 7300 unique downloads have occurred since launch. Our national survey revealed that of the total respondents (N = 171, 93.6% 3rd-year clerks, 31.6% uOttawa students), 97.1% (n = 166) had used the handbook on shift. A majority were able to find an answer to their clinical question either fully (53%, n = 88) or partially (46.4%, n = 77) and many would recommend this resource as-is (62.7%, n = 104) or with some modifications (34.3%, n = 57). Compared to the student's preferred clinical resource, mean Likert-type scores showed a significant (p < 0.01) positive difference in favor of the handbook regarding themes of organization (3.83 vs. 4.38), length (3.43 vs. 4.76) and ease in accessibility (3.46 vs. 4.79). Conclusion: The value of this handbook for junior learners entering their acute care rotation is evident. We demonstrated that student uptake of this handbook was robust. Compared to commonly used resources, students felt this handbook was more organized, concise in length, and easy to integrate into their clinical workflow. Implementation of this handbook across Canadian EM curriculums may bridge the EM knowledge gap in junior learners and off-service residents.
OBJECTIVES/SPECIFIC AIMS: To establish an effective team of researchers working towards developing and validating prognostic models employing use of image analyses and other numerical metadata to better understand pediatric undernutrition, and to learn how different approaches can be brought together collaboratively and efficiently. METHODS/STUDY POPULATION: Over the past 18 months we have established a transdisciplinary team spanning three countries and the Schools of Medicine, Engineering, Data Science and Global Health. We first identified two team leaders specifically a pediatric physician scientist (SS) and a data scientist/engineer (DB). The leaders worked together to recruit team members, with the understanding that different ideas are encouraged and will be used collaboratively to tackle the problem of pediatric undernutrition. The final data analytic and interpretative core team consisted of four data science students, two PhD students, an undergraduate biology major, a recent medical graduate, and a PhD research scientist. Additional collaborative members included faculty from Biomedical Engineering, the School of Medicine (Pediatrics and Pathology) along with international Global Health faculty from Pakistan and Zambia. We learned early on that it was important to understand what each of the member’s motivation for contributing to the project was along with aligning that motivation with the overall goals of the team. This made us help prioritize team member tasks and streamline ideas. We also incorporated a mechanism of weekly (monthly/bimonthly for global partners) meetings with informal oral presentations which consisted of each member’s current progress, thoughts and concerns, and next experimental goals. This method enabled team leaders to have a 3600 mechanism of feedback. Overall, we assessed the effectiveness of our team by two mechanisms: 1) ongoing team member feedback, including team leaders, and 2) progress of the research project. RESULTS/ANTICIPATED RESULTS: Our feedback has shown that on initial development of the team there was hesitance in communication due to the background diversity of our various member along with different cultural/social expectations. We used ice-breaking methods such as dedicated time for brief introductions, career directions, and life goals for each team member. We subsequently found that with the exception of one, all other team members noted our working environment professional and conducive to productivity. We also learnt from our method of ongoing constant feedback that at times, due to the complexity of different disciplines, some information was lost due to the difference in educational backgrounds. We have now employed new methods to relay information more effectively, with the use of not just sharing literature but also by explaining the content. The progress of our research project has varied over the past 4-6 months. There was a steep learning curve for almost every member, for example all the data science students had never studied anything related to medicine during their education, including minimal if none exposure to the ethics of medical research. Conversely, team members with medical/biology backgrounds had minimal prior exposure to computational modeling, computer engineering and the verbage of communicating mathematical algorithms. While this may have slowed our progress we learned that by asking questions and engaging every member it was easier to delegate tasks effectively. Once our team reached an overall understanding of each member’s goals there was a steady progress in the project, with new results and new methods of analysis being tested every week. DISCUSSION/SIGNIFICANCE OF IMPACT: We expect that our on-going collaboration will result in the development of new and novel modalities to understand and diagnose pediatric undernutrition, and can be used as a model to tackle several other problems. As with many team science projects, credit and authorship are challenges that we are outlining creative strategies for as suggested by International Committee of Medical Journal Editors (ICMJE) and other literature.
Nanohybrids containing graphene and bismuth ferrite have been actively employed as efficient photo-catalysts these days owing to the low rate of charge carrier's (e−–h+) recombination, moderate surface area with a suitable range of band-gaps. We have synthesized nanohybrids of graphene oxide (GO) and doped BiFeO3 using a co-precipitation method and the doping elements were lanthanum and manganese, hence called BLFMO/GO nanohybrids. The surface area of BLFMO [La = 15% increased from 6.8 m2/g (for pure) to 62.68 m2/g (in nanohybrid)]. Also, the bandgap of the BLFMO/GO nanohybrid reduced significantly up to 1.75 eV. The resulting BLFMO/GO nanohybrid represents significantly higher catalytic activity (96% in 30 min) than the pure BiFeO3 (30% in 30 min).
CIC, or Capicua, encodes a transcriptional repressor that is itself repressed by RAS/MAPK signalling. CIC is a recurrent target of somatic mutation in type 1 low grade gliomas (LGG), with at least half of the alterations predicted to be deleterious. Type 1 LGGs are a cohort of tumours that are molecularly defined by the loss of heterozygosity of chromosome arms 1p and 19q and the presence of neomorphic IDH1/2 mutations. Despite the high frequency of mutations in CIC within this tumour type, CIC’s putative tumour suppressive role remains to be elucidated. It is also unclear how CIC may cooperate with neomorphic IDH1/2 to promote gliomagenesis. To comprehensively characterize the molecular consequences of CIC loss, we performed RNA-seq, Whole Genome Bisulfite Sequencing, and ChIP-seq on 6 different histone modifications on isogenic CIC-wildtype (WT) and CIC-knockout (KO) normal human astrocytes. To also investigate the collective effects of CIC deficiency and neomorphic IDH1 on the transcriptome and epigenome, we generated the same dataset in isogenic CIC-WT and CIC-KO astrocytes possessing the IDH1 R132H mutation. Analysis of differentially expressed genes illustrates the enrichment of oncogenic pathways in specifically the CIC-KO, IDH1-R132H cells, supporting a synergistic relationship between CIC loss and IDH1-R132H in driving tumour progression. Integrative analyses are ongoing to unveil the epigenetic mechanisms underpinning the regulatory changes in these isogenic cell line models.
Cinnamon is a common spice obtained from the bark of the cinnamon tree (Cinnamomum zeylanicum). It has been used for culinary, as well as medicinal, purposes since ancient times in various countries. Apart from substantial amounts of several nutrients, including carbohydrates, proteins, choline, vitamins (A, K, C, B3), and minerals, several biological active compounds are present in the extract of oil, which contribute to immunomodulatory, antioxidant, antiviral, lowering blood cholesterol, antimicrobial, lipid-lowering, antihypertension, anti-inflammatory, antitumor, gastroprotective, antidiabetic, neuroprotective and blood purifying properties. Cinnamon roots serve as a hepatic stimulant by improving bile production, eliminating toxins, restoring electrolyte balance and regulating hydration and can be used for enhancing digestion. In addition, nutritional properties of cinnamon powder include positive effects regarding growth, digestion, enhanced activity of gut microflora, improvement of immune response, as well as improved feed efficiency and health improvement of poultry birds. Recently, research focus has been directed towards supplementing broiler diets with cinnamon powder as a phytobiotic in order to replace synthetic growth promoters. After reviewing the literature, it was found that the research at the molecular level to elucidate the mechanisms behind the potential of cinnamon as a feed additive in poultry is limited, despite its promising impacts. Furthermore, supplementation doses vary significantly, i.e., from 0.02 to 7%. So, the aim of this review was to compile the published research related to cinnamon. Hence explore its beneficial properties, find out its optimal dosage for uses by veterinarians, researchers, and nutritionists, as well as its potential to use as a natural feed additive to replace the synthetic antibiotic growth promoters in poultry feed.
Anthocyanins are flavonoids widely spread in various plant species as a major phyto-pigment. In recent years, interest in using anthocyanins as a feed ingredient has increased markedly owing to their health and other benefits. Anthocyanins possess various pharmacological properties, including anti-inflammatory, immunomodulatory, anticancer, antidiabetic, neuroprotective, anti-obesity and antioxidant effects. Dietary consumption of anthocyanins has revealed benefits in animal performance. Little is known about health-promoting effects of anthocyanins in avian species, but anthocyanin-rich dried fruits have shown positive effects on certain pathological conditions and health promoting markers in human and other animals. This review aims to gather information regarding health benefits of anthocyanins and highlight therapeutic and potential health beneficial effects of anthocyanins for poultry. Additionally, it explores these biologically important flavonoids as alternative ingredients in poultry feed to replace synthetic nutrients and medicines. The available literature reports studies involving use of anthocyanins focused on human, mice and in vitro models. However, there is a need to explore mechanism of action at molecular level to understand potential beneficial effects of anthocyanins in avian species.
Low-density, highly porous graphene/graphene oxide (GO) based-foams have shown high performance in energy absorption applications, even under high compressive deformations. In general, foams are very effective as energy dissipative materials and have been widely used in many areas such as automotive, aerospace and biomedical industries. In the case of graphene-based foams, the good mechanical properties are mainly attributed to the intrinsic graphene and/or GO electronic and mechanical properties. Despite the attractive physical properties of graphene/GO based-foams, their structural and thermal stabilities are still a problem for some applications. For instance, they are easily degraded when placed in flowing solutions, either by the collapsing of their layers or just by structural disintegration into small pieces. Recently, a new and scalable synthetic approach to produce low-density 3D macroscopic GO structure interconnected with polydimethylsiloxane (PDMS) polymeric chains (pGO) was proposed. A controlled amount of PDMS is infused into the freeze-dried foam resulting into a very rigid structure with improved mechanical properties, such as tensile plasticity and toughness. The PDMS wets the graphene oxide sheets and acts like a glue bonding PDMS and GO sheets. In order to obtain further insights on mechanisms behind the enhanced mechanical pGO response we carried out fully atomistic molecular dynamics (MD) simulations. Based on MD results, we build up a structural model that can explain the experimentally observed mechanical behavior.
Background: Neurosurgical residents face a unique combination of challenges, including long duty hours, technically challenging cases, and uncertain employment prospects. We sought to assess the demographics, interests, career goals, self-rated happiness, and overall well-being of Canadian neurosurgery residents. Methods: A cross-sectional survey was developed and sent through the Canadian Neurosurgery Research Collaborative to every resident enrolled in a Canadian neurosurgery program as of April 1, 2016. Results: We analyzed 76 completed surveys of 146 eligible residents (52% response rate). The median age was 29 years, with 76% of respondents being males. The most popular subspecialties of interest for fellowship were spine, oncology, and open vascular neurosurgery. The most frequent self-reported number of worked hours per week was the 80- to 89-hour range. The majority of respondents reported a high level of happiness as well as stress. Sense of accomplishment and fatigue were reported as average to high and overall quality of life was low for 19%, average for 49%, and high for 32%. Satisfaction with work-life balance was average for 44% of respondents and was the only tested domain in which significant dissatisfaction was identified (18%). Overall, respondents were highly satisfied with their choice of specialty, choice of program, surgical exposure, and work environment; however, intimidation was reported in 36% of respondents and depression by 17%. Conclusions: Despite a challenging residency and high workload, the majority of Canadian neurosurgery residents are happy and satisfied with their choice of specialty and program. However, work-life balance, employability, resident intimidation, and depression were identified as areas of active concern.
Background Currently, the literature lacks reliable data regarding operative case volumes at Canadian neurosurgery residency programs. Our objective was to provide a snapshot of the operative landscape in Canadian neurosurgical training using the trainee-led Canadian Neurosurgery Research Collaborative. Methods: Anonymized administrative operative data were gathered from each neurosurgery residency program from January 1, 2014, to December 31, 2014. Procedures were broadly classified into cranial, spine, peripheral nerve, and miscellaneous procedures. A number of prespecified subspecialty procedures were recorded. We defined the resident case index as the ratio of the total number of operations to the total number of neurosurgery residents in that program. Resident number included both Canadian medical and international medical graduates, and included residents on the neurosurgery service, off-service, or on leave for research or other personal reasons. Results: Overall, there was an average of 1845 operative cases per neurosurgery residency program. The mean numbers of cranial, spine, peripheral nerve, and miscellaneous procedures were 725, 466, 48, and 193, respectively. The nationwide mean resident case indices for cranial, spine, peripheral nerve, and total procedures were 90, 58, 5, and 196, respectively. There was some variation in the resident case indices for specific subspecialty procedures, with some training programs not performing carotid endarterectomy or endoscopic transsphenoidal procedures. Conclusions: This study presents the breadth of neurosurgical training within Canadian neurosurgery residency programs. These results may help inform the implementation of neurosurgery training as the Royal College of Physicians and Surgeons residency training transitions to a competence-by-design curriculum.
To ascertain determinants of an interest in a career in ENT surgery through a survey of medical students and junior doctors.
A survey was administered, comprising Likert scales, forced response and single option questions, and free text responses, at five different courses or events for those interested in a career in ENT.
The survey had an 87 per cent response rate; respondents consisted of 43 applicants for national selection, 15 foundation doctors and 23 medical students. The most important factors that encourage ENT as a career included: the variety of operative procedures, work–life balance, inherent interest in this clinical area and inspirational senior role models. Exposure to ENT in undergraduate or post-graduate training is critical in deciding to pursue this specialty.
It is important to promote those aspects of ENT surgery that attract people to it, and to argue for greater exposure to ENT during undergraduate and post-graduate training.
In recent years, the government of Bangladesh has encouraged private sector involvement in producing mid-level health cadres including Medical Assistants (MAs). The number of MAs produced has increased significantly. We assessed students’ characteristics, educational services, competencies and perceived attitudes towards health service delivery in rural areas.
We used a mixed method approach using quantitative (questionnaire survey) and qualitative (key informant interviews and roundtable discussion) methods. Altogether, five public schools with 238 students and 30 private schools with 732 students were included. Statistical analyses were performed using STATA v-12. Qualitative data were analyzed thematically.
The majority of the students in both public (66%) and private medical assistant training schools (MATS) (61%) were from rural backgrounds. They spent the majority of their time in classroom learning (public 45% versus private 42%) and the written essay exam was the common form of a students’ performance assessment. Compared with students of public MATS, students of private MATS were more confident in different aspects of educational areas, including managing emerging health needs (P<0.001); evidence-based practice (P=0.002); critical thinking and problem solving (P=0.02), and use of IT/computer skills (P<0.001). Students were aware of not having adequate facilities in rural areas (public 71%, private 65%), but they perceived working in rural areas will offer several benefits, including use of learnt skills; friendly rural people; and opportunities for real-life problem solving, etc.
This study provides a current picture of MATS students’ characteristics, educational services, competencies and perception towards working in rural areas. The MA students in both private and public sectors showed a greater level of willingness to serve in rural health facilities. The results are promising to improve health service delivery, particularly in rural and hard-to-reach areas of Bangladesh.