Relevance of anatomy to medical education and clinical practice: perspectives of medical students, clinicians, and educators

Introduction: Against a backdrop of ever-changing diagnostic and treatment modalities, stakeholder perceptions (medical students, clinicians, anatomy educators) are crucial for the design of an anatomy curriculum which fulfils the criteria required for safe medical practice. This study compared perceptions of students, practising clinicians, and anatomy educators with respect to the relevance of anatomy education to medicine. Methods: A quantitative survey was administered to undergraduate entry (n = 352) and graduate entry students (n = 219) at two Irish medical schools, recently graduated Irish clinicians (n = 146), and anatomy educators based in Irish and British medical schools (n = 30). Areas addressed included the association of anatomy with medical education and clinical practice, mode of instruction, and curriculum duration. Results: Graduate-entry students were less likely to associate anatomy with the development of professionalism, teamwork skills, or improved awareness of ethics in medicine. Clinicians highlighted the challenge of tailoring anatomy education to increase student readiness to function effectively in a clinical role. Anatomy educators indicated dissatisfaction with the time available for anatomy within medical curricula, and were equivocal about whether curriculum content should be responsive to societal feedback. Conclusions: The group differences identified in the current study highlight areas and requirements which medical education curriculum developers should be sensitive to when designing anatomy courses.

Diaphragm muscle adaptation to sustained hypoxia: lessons from animal models with relevance to high altitude and chronic respiratory diseases

The diaphragm is the primary inspiratory pump muscle of breathing. Notwithstanding its critical role in pulmonary ventilation, the diaphragm like other striated muscles is malleable in response to physiological and pathophysiological stressors, with potential implications for the maintenance of respiratory homeostasis. This review considers hypoxic adaptation of the diaphragm muscle, with a focus on functional, structural, and metabolic remodeling relevant to conditions such as high altitude and chronic respiratory disease. On the basis of emerging data in animal models, we posit that hypoxia is a significant driver of respiratory muscle plasticity, with evidence suggestive of both compensatory and deleterious adaptations in conditions of sustained exposure to low oxygen. Cellular strategies driving diaphragm remodeling during exposure to sustained hypoxia appear to confer hypoxic tolerance at the expense of peak force-generating capacity, a key functional parameter that correlates with patient morbidity and mortality. Changes include, but are not limited to: redox-dependent activation of hypoxia-inducible factor (HIF) and MAP kinases; time-dependent carbonylation of key metabolic and functional proteins; decreased mitochondrial respiration; activation of atrophic signaling and increased proteolysis; and altered functional performance. Diaphragm muscle weakness may be a signature effect of sustained hypoxic exposure. We discuss the putative role of reactive oxygen species as mediators of both advantageous and disadvantageous adaptations of diaphragm muscle to sustained hypoxia, and the role of antioxidants in mitigating adverse effects of chronic hypoxic stress on respiratory muscle function.

Effects of gestational and postnatal exposure to chronic intermittent hypoxia on diaphragm muscle contractile function in the rat

Alterations to the supply of oxygen during early life presents a profound stressor to physiological systems with aberrant remodeling that is often long-lasting. Chronic intermittent hypoxia (CIH) is a feature of apnea of prematurity, chronic lung disease, and sleep apnea. CIH affects respiratory control but there is a dearth of information concerning the effects of CIH on respiratory muscles, including the diaphragm—the major pump muscle of breathing. We investigated the effects of exposure to gestational CIH (gCIH) and postnatal CIH (pCIH) on diaphragm muscle function in male and female rats. CIH consisted of exposure in environmental chambers to 90 s of hypoxia reaching 5% O2 at nadir, once every 5 min, 8 h a day. Exposure to gCIH started within 24 h of identification of a copulation plug and continued until day 20 of gestation; animals were studied on postnatal day 22 or 42. For pCIH, pups were born in normoxia and within 24 h of delivery were exposed with dams to CIH for 3 weeks; animals were studied on postnatal day 22 or 42. Sham groups were exposed to normoxia in parallel. Following gas exposures, diaphragm muscle contractile, and endurance properties were examined ex vivo. Neither gCIH nor pCIH exposure had effects on diaphragm muscle force-generating capacity or endurance in either sex. Similarly, early life exposure to CIH did not affect muscle tolerance of severe hypoxic stress determined ex vivo. The findings contrast with our recent observation of upper airway dilator muscle weakness following exposure to pCIH. Thus, the present study suggests a relative resilience to hypoxic stress in diaphragm muscle. Co-ordinated activity of thoracic pump and upper airway dilator muscles is required for optimal control of upper airway caliber. A mismatch in the force-generating capacity of the complementary muscle groups could have adverse consequences for the control of airway patency and respiratory homeostasis.

Defending the 'public interest': an assessment of competing actor representations of 'solutions' to growing natural resource deficiencies.

This paper applies a SRT framework to the study of two case studies, namely the recent campaign of opposition to the legalization of hydraulic fracking in the State of New York and the more ongoing debate on land leasing in Africa. In relation to both campaigns, the analysis accounts for the arguments of a major financial institution and industry representatives who stress the safe and value-adding dimensions of these practices, as well as the views of opponents who refute the validity of industry's position and point to the unacceptable risks posed to the community, health and the environment. In spite of a number of obvious differences between these two case studies, not least differences arising from contrasting socio-economic and geo-political settings, there were also some notable similarities. First, was a tendency amongst protesters in both cases to formulate their role as contemporaries in a historically extended struggle for democratic justice. All perceived of themselves as guardians of their community's right to resist a corporate 'invasion' of their territories, like their forefathers and mothers before them. A theme of colonialism was explored in both settings through various identity and thematic anchoring devices that deliberately evoked shared understandings and historical memories of exploitation and human suffering. The evocation of powerful symbols of identity through visual narratives of protest further reinforced the cultural comprehensibility of opponents' message of protest in both contexts.

Barriers and facilitators to initial and continued attendance at community-based lifestyle programmes among families of overweight and obese children: a systematic review

The success of childhood weight management programmes relies on family engagement. While attendance offers many benefits including the support to make positive lifestyle changes, the majority of families referred to treatment decline. Moreover, for those who do attend, benefits are often compromised by high programme attrition. This systematic review investigated factors influencing attendance at community-based lifestyle programmes among families of over-weight or obese children. A narrative synthesis approach was used to allow for the inclusion of quantitative, qualitative and mixed-method study designs. Thirteen studies met the inclusion criteria. Results suggest that parents provided the impetus for programme initiation, and this was driven largely by a concern for their child's psychological health and wellbeing. More often than not, children went along without any real reason or interest in attending. Over the course of the programme, however, children's positive social experiences such as having fun and making friends fostered the desire to continue. The stigma surrounding excess weight and the denial of the issue amongst some parents presented barriers to enrolment and warrant further study. This study provides practical recommendations to guide future policy makers, programme delivery teams and researchers in developing strategies to boost recruitment and minimise attrition.

Investigating key decision problems to optimize the operation and maintenance strategy of offshore wind farms

This paper investigates three decision problems with potential to optimize operation and maintenance and logistics strategies for offshore wind farms: the timing of pre-determined jack-up vessel campaigns; selection of crew transfer vessel fleet; and timing of annual services. These problems are compared both in terms of potential cost reduction and the stochastic variability and associated uncertainty of the outcome. Pre-determined jack-up vessel campaigns appear to have a high cost reduction potential but also a higher stochastic variability than the other decision problems. The paper also demonstrates the benefits and difficulties of considering problems together rather than solving them in isolation.

Early life exposure to chronic intermittent hypoxia primes increased susceptibility to hypoxia-induced weakness in rat sternohyoid muscle during adulthood

Intermittent hypoxia is a feature of apnea of prematurity (AOP), chronic lung disease, and sleep apnea. Despite the clinical relevance, the long-term effects of hypoxic exposure in early life on respiratory control are not well defined. We recently reported that exposure to chronic intermittent hypoxia (CIH) during postnatal development (pCIH) causes upper airway muscle weakness in both sexes, which persists for several weeks. We sought to examine if there are persistent sex-dependent effects of pCIH on respiratory muscle function into adulthood and/or increased susceptibility to re-exposure to CIH in adulthood in animals previously exposed to CIH during postnatal development. We hypothesized that pCIH would cause long-lasting muscle impairment and increased susceptibility to subsequent hypoxia. Within 24 h of delivery, pups and their respective dams were exposed to CIH: 90 s of hypoxia reaching 5% O2 at nadir; once every 5 min, 8 h per day for 3 weeks. Sham groups were exposed to normoxia in parallel. Three groups were studied: sham; pCIH; and pCIH combined with adult CIH (p+aCIH), where a subset of the pCIH-exposed pups were re-exposed to the same CIH paradigm beginning at 13 weeks. Following gas exposures, sternohyoid and diaphragm muscle isometric contractile and endurance properties were examined ex vivo. There was no apparent lasting effect of pCIH on respiratory muscle function in adults. However, in both males and females, re-exposure to CIH in adulthood in pCIH-exposed animals caused sternohyoid (but not diaphragm) weakness. Exposure to this paradigm of CIH in adulthood alone had no effect on muscle function. Persistent susceptibility in pCIH-exposed airway dilator muscle to subsequent hypoxic insult may have implications for the control of airway patency in adult humans exposed to intermittent hypoxic stress during early life.

Using a discussion about scientific controversy to teach central concepts in experimental design

Students may need explicit training in informal statistical reasoning in order to design experiments or use formal statistical tests effectively. By using scientific scandals and media misinterpretation, we can explore the need for good experimental design in an informal way. This article describes the use of a paper that reviews the measles mumps rubella vaccine and autism controversy in the UK to illustrate a number of threshold concepts underlying good study design and interpretation of scientific evidence. These include the necessity of sufficient sample size, representative and random sampling, appropriate controls and inferring causation.

Homesick for the unheimlich: back to the uncanny future in Alien: Isolation

In 2014 Sega released Creative Assembly’s Alien: Isolation, a video game sequel to the 1979 film Alien. As an attempt to create both an authentic homage to the Alien franchise and a credible successor to Ridley Scott’s original film, Alien: Isolation was received as both a work of remediated nostalgia and as a deeply uncanny survival horror. This article discusses Alien: Isolation framed by theories of the uncanny (the unhomely) and of nostalgia (the homely), with the aim of revealing how the production design of the game reconciled these seemingly contradictory but nonetheless overlapping aesthetic qualities. By drawing on examples from Alien: Isolation’s visual and level design, this article discusses how the integration of nostalgic and uncanny qualities could be of value to horror and sci-fi game design, in particular to the development of sequels within existing franchises, and to remediations, remakes and reboots.

Use of bird carcass removals by urban scavengers to adjust bird-window collision estimates

Carcass removal by scavengers has been identified as one of the largest biases in estimating bird mortality from anthropogenic sources. Only two studies have examined carcass removal by scavengers in an urban environment, and previous estimates of bird-window collision mortality at houses have relied on carcass removal rates from wind turbine studies. We placed a bird carcass and time-lapse camera at 44 houses in Edmonton, Alberta. In total, 166 7-day trials were conducted throughout 2015. Time-to-event (survival) analysis was used to identify covariates that affected removal. The carcass removal rate was determined for use in estimating the number of birds killed from bird-window collisions at houses in Alberta. In total, 67.5% of carcasses were removed. The date the carcass was placed, the year the house was built, and the level of development within 50 m of the house were the covariates that had the largest effect on carcass removal. In calculating our removal rate, the number of detected carcasses in the first 24 hours was adjusted by 1.47 to account for removal by scavengers. Previously collected citizen science data were used to create an estimate of 957,440 bird deaths each year in Alberta as a result of bird-window collisions with houses. This number is based on the most detailed bird-window collision study at houses to date and a carcass removal study conducted in the same area. Similar localized studies across Canada will need to be completed to reduce the biases that exist with the previous bird-window collision mortality estimate for houses in Canada.

Diet composition of a declining steppe bird the Little Bustard (Tetrax tetrax) in relation to farming practices

Foraging strategies and diet selection play an essential role in individual survival and reproductive success. The study of feeding ecology becomes crucial when it concerns endangered species such as the Little Bustard (Tetrax tetrax), whose populations are suffering strong declines as a consequence of agricultural intensification. Despite the fact that several populations are overwintering in areas affected by agricultural transformation, nothing is known about how feeding behavior responds to these changes. We studied for the first time the winter diet composition of the Little Bustard in Spain and compared it between areas with two different farming systems: dry and irrigated farmland. Diet was studied through the micro-histological analysis of 357 droppings collected in 16 locations across the wintering range of the Little Bustard in Spain. Up to 62 plant species were identified. Most consumed species were cultivated legumes (46.7%) and dicotyledon weeds (45.6%), while monocotyledons were scarcely consumed (7.7%). Diet composition differed significantly between dry and irrigated farmland areas. In irrigated areas, diet was mainly composed of legumes, in particular alfalfa (Medicago sativa). In contrast, in dry farmland areas diet was more diverse, composed mainly of weeds (Compositae, Papaveraceae, and Cruciferae) and also cultivated legumes, particularly vetch (Vicia sativa). These results suggest that legume crops could be an effective measure to improve habitat quality in areas with scarce food resources. However, in the case of irrigated areas, the strong reliance on alfalfa could make the Little Bustard more vulnerable to changes in land use. This study is the first step to understand the winter trophic requirements of the endangered Little Bustard, but further research is necessary to understand the food requirements of this species during the entire annual cycle.