"Should I prioritize medical problem solving or attentive listening?": the dilemmas and challenges that medical students experience when learning to conduct consultations

Objective: Communication skills can be trained alongside clinical reasoning, history taking or clinical examination skills. This is advocated as a solution to the low transfer of communication skills. Still, students have to integrate the knowledge/skills acquired during different curriculum parts in patient consultations at some point. How do medical students experience these integrated consultations within a simulated environment and in real practice when dealing with responsibility?

Methods: Six focus groups were conducted with (pre-)/clerkship students.

Results: Students were motivated to practice integrated consultations with simulated patients and felt like 'real physicians'. However, their focus on medical problem solving drew attention away from improving their communication skills. Responsibility for real patients triggered students' identity development. This identity formation guided the development of an own consultation style, a process that was hampered by conflicting demands of role models.

Conclusion: Practicing complete consultations results in the dilemma of prioritizing medical problem solving above attention for patient communication. Integrated consultation training advances this dilemma to the pre-clerkship period. During clerkships this dilemma is heightened because real patients trigger empathy and responsibility, which invites students to define their role as doctor.

Practice Implications: When training integrated consultations, educators should pay attention to students' learning priorities and support the development of students' professional identity.

Violation of Bell inequalities in larger Hilbert spaces: robustness and challenges

We explore the challenges posed by the violation of Bell-like inequalities by d-dimensional systems exposed to imperfect state-preparation and measurement settings. We address, in particular, the limit of high-dimensional systems, naturally arising when exploring the quantum-to-classical transition. We show that, although suitable Bell inequalities can be violated, in principle, for any dimension of given subsystems, it is in practice increasingly challenging to detect such violations, even if the system is prepared in a maximally entangled state. We characterize the effects of random perturbations on the state or on the measurement settings, also quantifying the efforts needed to certify the possible violations in case of complete ignorance on the system state at hand.

Application of SNPs for population genetics of nonmodel organisms:new opportunities and challenges

Recent improvements in the speed, cost and accuracy of next generation sequencing are revolutionizing the discovery of single nucleotide polymorphisms (SNPs). SNPs are increasingly being used as an addition to the molecular ecology toolkit in nonmodel organisms, but their efficient use remains challenging. Here, we discuss common issues when employing SNP markers, including the high numbers of markers typically employed, the effects of ascertainment bias and the inclusion of nonneutral loci in a marker panel. We provide a critique of considerations specifically associated with the application and population genetic analysis of SNPs in nonmodel taxa, focusing specifically on some of the most commonly applied methods.

Microbicide Vaginal Rings: Technological Challenges and Clinical Development

Vaginal rings (VRs) are flexible, torus-shaped, polymeric devices designed to sustain delivery of pharmaceutical drugs to the vagina for clinical benefit. Following first report in a 1970 patent application, several steroid-releasing VR products have since been marketed for use in hormone replacement therapy and contraception. Since 2002, there has been growing interest in the use of VR technology for delivery of drugs that can reduce the risk of sexual acquisition of human immunodeficiency virus type 1 (HIV-1), the causative agent of acquired immunodeficiency syndrome (AIDS). Although no vaginally-administered product has yet been approved for HIV reduction/prevention, extensive research efforts are continuing and a number of VR devices offering sustained release of so-called ‘HIV microbicide’ compounds are currently being evaluated in late-stage clinical studies. This review article provides an overview of the published scientific literature within this important field of research, focusing primarily on articles published within peer-reviewed journal publications. Many important aspects of microbicide-releasing VR technology are discussed, with a particular emphasis on the technological, manufacturing and clinical challenges that have emerged in recent years.

Sustainable non-automotive vehicles: The simulation challenges

Simulation is a well-established and effective approach to the development of fuel-efficient and low-emissions vehicles in both on-highway and off-highway applications.

The simulation of on-highway automotive vehicles is widely reported in literature, whereas research relating to non-automotive and off-highway vehicles is relatively sparse. This review paper focuses on the challenges of simulating such vehicles and discusses the differences in the approach to drive cycle testing and experimental validation of vehicle simulations. In particular, an inner-city diesel-electric hybrid bus and an ICE (Internal Combustion Engine) powered forklift truck will be used as case studies.

Computer prediction of fuel consumption and emissions of automotive vehicles on standardised drive cycles is well-established and commercial software packages such as AVL CRUISE have been specifically developed for this purpose. The vehicles considered in this review paper present new challenges from both the simulation and drive-cycle testing perspectives. For example, in the case of the forklift truck, the drive cycles involve reversing elements, variable mass, lifting operations, and do not specify a precise velocity-time profile. In particular, the difficulties associated with the prediction of productivity, i.e. the maximum rate of completing a series of defined operations, are discussed. In the case of the hybrid bus, the standardised drive cycles are unrepresentative of real-life use and alternative approaches are required in the development of efficient and low-emission vehicles.

Two simulation approaches are reviewed: the adaptation of a standard automotive vehicle simulation package, and the development of bespoke models using packages such as MATLAB/Simulink.