Development of decision aid on health help-seeking for medical students.

BACKGROUND: Rates of mental health problems are increasing among medical students, who have added pressures compared with non-medical students. Medical student populations exhibit low rates of help-seeking and often struggle with disclosing health conditions due to the barriers experienced and concerns over negative repercussions. AIMS: This study aimed to create and test the feasibility and potential efficacy of an online decision aid (DA) tool that provides medical students with resources for disclosing and help-seeking for their health concerns. METHODS: The research used mixed methods, comprising two rounds of testing, the first used the Think-Aloud method to identify modifications needed, and both of which measured feasibility and assessed decision making outcomes pre and post use of the DA utilizing O'Connor's Decisional Conflict Scale (DCS) (2010) and Stage of Decision Making (SDM) (2003) measures. RESULTS: Results showed good feasibility of the DA. The mean DCS total score decreased from 32 to 16.75, (Wilcoxon signed-rank tests Z = -3.06, P < 0.05). There was no significant change in the SDM. CONCLUSIONS: The results suggest that the DA may reduce decisional conflict, improving their certainty and confidence in decision making, but had no immediate impact on their SDM, consistent with some other DAs. Further longitudinal research would be beneficial.

Probabilistic detection of volcanic ash using a Bayesian approach.

Airborne volcanic ash can pose a hazard to aviation, agriculture, and both human and animal health. It is therefore important that ash clouds are monitored both day and night, even when they travel far from their source. Infrared satellite data provide perhaps the only means of doing this, and since the hugely expensive ash crisis that followed the 2010 Eyjafjalljökull eruption, much research has been carried out into techniques for discriminating ash in such data and for deriving key properties. Such techniques are generally specific to data from particular sensors, and most approaches result in a binary classification of pixels into "ash" and "ash free" classes with no indication of the classification certainty for individual pixels. Furthermore, almost all operational methods rely on expert-set thresholds to determine what constitutes "ash" and can therefore be criticized for being subjective and dependent on expertise that may not remain with an institution. Very few existing methods exploit available contemporaneous atmospheric data to inform the detection, despite the sensitivity of most techniques to atmospheric parameters. The Bayesian method proposed here does exploit such data and gives a probabilistic, physically based classification. We provide an example of the method's implementation for a scene containing both land and sea observations, and a large area of desert dust (often misidentified as ash by other methods). The technique has already been successfully applied to other detection problems in remote sensing, and this work shows that it will be a useful and effective tool for ash detection. KEY POINTS: Presentation of a probabilistic volcanic ash detection schemeMethod for calculation of probability density function for ash observationsDemonstration of a remote sensing technique for monitoring volcanic ash hazards.

Progression from first symptom to diagnosis in childhood brain tumours.

This study was undertaken to investigate the evolution of clinical features between onset of symptoms and diagnosis in children with brain tumours and to identify ways of shortening the time to diagnosis. One hundred and thirty-nine children with a brain tumour were recruited from four UK paediatric neuro-oncology centres. Children had a median of one symptom or sign at symptom onset and six by diagnosis. The symptoms and/or signs experienced at symptom onset and at diagnosis were as follows: headache in 55 and 81 children, nausea and vomiting in 39 and 88 children, motor system abnormalities in 31 and 93 children, cranial nerve palsies in 24 and 75 children, visual system abnormalities in 23 and 96 children, endocrine or growth abnormalities in 10 and 35 children and behavioural change in 4 and 55 children. The median time between symptom onset and diagnosis (symptom interval) was 3.3 months. A longer symptom interval was associated with head tilt, cranial nerve palsies, endocrine and growth abnormalities and reduced visual acuity. More than half of children with brain tumours developed problems with vision and more than a third developed motor problems, cranial nerve palsies, behavioural change, or nausea and vomiting between symptom onset and diagnosis.

An investigation of the expression and adhesin function of H7 flagella in the interaction of Escherichia coli O157 : H7 with bovine intestinal epithelium.

Enterohaemorrhagic Escherichia coli O157 : H7 is a bacterial pathogen that can cause haemorrhagic colitis and haemolytic uremic syndrome. In the primary reservoir host, cattle, the terminal rectum is the principal site of E. coli O157 colonization. In this study, bovine terminal rectal primary epithelial cells were used to examine the role of H7 flagella in epithelial adherence. Binding of a fliC(H7) mutant O157 strain to rectal epithelium was significantly reduced as was binding of the flagellated wild-type strain following incubation with H7-specific antibodies. Complementation of fliC(H7) mutant O157 strain with fliC(H7) restored the adherence to wild-type levels; however, complementation with fliC(H6) did not restore it. High-resolution ultrastructural and imunofluorescence studies demonstrated the presence of abundant flagella forming physical contact points with the rectal epithelium. Binding to terminal rectal epithelium was specific to H7 by comparison with other flagellin types tested. In-cell Western assays confirmed temporal expression of flagella during O157 interaction with epithelium, early expression was suppressed during the later stages of microcolony and attaching and effacing lesion formation. H7 flagella are expressed in vivo by individual bacteria in contact with rectal mucosa. Our data demonstrate that the H7 flagellum acts as an adhesin to bovine intestinal epithelium and its involvement in this crucial initiating step for colonization indicates that H7 flagella could be an important target in intervention strategies.