Board affiliate pilot: leadership and innovation—creating new opportunities to deliver better patient care

BackgroundLeadership and management have become a key facet of medical training. However, there remains enormous variation in the quality and effectiveness of medical leadership training. This article describes an innovative pilot programme that aimed to prove a new method of developing clinical leaders.MethodsWe undertook a 12-month pilot integrating a doctor in training onto our trust board in a role called the ‘board affiliate’. We collected qualitative and quantitative data throughout our pilot programme.ResultsQualitative data demonstrated a clear positive impact of this role on senior management and clinical staff. Our staff survey results increased from 47.4% to 50.3%. The pilot programme has had such an impact on our organisation that we have expanded the single pilot role into two positions.ConclusionThis pilot programme has demonstrated a new and effective method of developing clinical leaders.

Personalizing Medicine and Technologies to Address the Experiences and Needs of People with Multiple Sclerosis

There is enormous variation in the manifestations of disease experienced by people with multiple sclerosis (PwMS). While this variation makes personalized medicine an attractive goal, there are many challenges to be overcome before this opportunity can be realized. Personalized medicine often focuses on targeted therapies and detailed monitoring, but we also need to recognize that there will be variation in acceptance of these approaches by different PwMS. In other words, deep personalization of medicine will encompass targeted therapy, precision monitoring, tailored to variation in personal attitudes to these transformations in health care. In order to meet the promise of personalized medicine for MS, understanding the experiences of PwMS is necessary both to aid in the uptake of personalized medicine, and to ensure that personalized approaches to monitoring disease and treatment provide a net benefit to PwMS rather than placing additional burdens and stressors on them. Here, we describe recent research that identified five experiential themes for PwMS, and then interpret these themes according to the foundations of personalized medicine to provide a road map for implementation of personalized medicine solutions for PwMS.

Tetraodontiformes (Osteichthyes, Actinopterygii) from the Miocene of Argentina: with the southernmost record of fossil Tetraodontidae

Teleostean evolution produced enormous variation in tooth morphology. This variation is related to the exploration and exploitation of very diverse dietary niches. Among extant fishes, several taxa of the order Tetraodontiformes (e.g. pufferfishes, porcupinefishes and ocean sunfishes) have evolved highly specialized beak-like tooth structures. Here we provide the first description of tetraodontiform crushing beaks from Argentina. A single complete premaxillary beak recovered from the early Miocene Gaiman Formation in Chubut Province is assigned to Molidae based on its premaxillaries being completely fused to one another along the midline, general morphology, and size. Moreover, due to the putative presence of rows of teeth fused to the thick and massive bone structure, the specimen might belong to the genus Ranzania Nardo, 1840. Several premaxillary beaks recovered in the late Miocene Paraná Formation of Entre Ríos Province are assigned to Tetraodontidae Bonaparte, 1832 based on the presence of long, slender, rod-like, and parallel dental units; premaxillae not fused in the midline but articulated by interlocking emarginations, and a few small and one large trituration dental units. Argentinian tetraodontiform fishes inhabited the warm-temperate Paranense and Patagoniense Seas (marine transgressions developed in southeastern South America) during the early-late Miocene; these specimens are the southernmost fossil record of the group worldwide. Tetraodontiforms are extremely rare in recent Argentinian marine waters. The new fossil records agree with the higher sea water surface temperatures suggested both locally and worldwide for the Miocene.

Collecting the Memories: The Potential of Augmented Reality Souvenirs in Agro-Tourism

Souvenirs are an essential artifact in tourism because tourists want to keep a memory of the places they visit. Despite the enormous variation in souvenirs, there are no decent souvenirs for agro-tourism in Indonesia. Agro-tourism allows tourists to experience the natural beauty of landscapes and to be exposed to farming products, making the agricultural products the souvenirs themselves. Some Indonesian agro-tourism provides undifferentiated souvenirs like keychains or T-shirts that exhibit the place’s logo, which we perceive as an opportunity to develop a novel design of souvenir. Our previous study about augmented reality products in agro-tourism delivered good outcomes but needs further research. This article explored the potential of developing agro-tourism souvenirs with technology to engage tourist enthusiasm with augmented reality. The researchers conducted literature studies, interviews and product testings to answer the main research question: “What is the tourist attitude towards augmented reality souvenirs in Indonesian agro-tourism?”. The findings during the prototype trial indicated that augmented reality souvenirs could escalate tourism experiences. However, we found there was a problem in human-computer interaction: some of the target audience’s tools cannot support the technology. Although the immersive sensation from augmented reality souvenirs potentially enhances the tourist experience, future studies about the effectiveness of its more extended implementation are necessary. Keywords: augmented reality souvenir, agro-tourism, souvenir, digital souvenir

Brain size predicts learning abilities in bees

When it comes to the brain, bigger is generally considered better in terms of cognitive performance. While this notion is supported by studies of birds and primates showing that larger brains improve learning capacity, similar evidence is surprisingly lacking for invertebrates. Although the brain of invertebrates is smaller and simpler than that of vertebrates, recent work in insects has revealed enormous variation in size across species. Here, we ask whether bee species that have larger brains also have higher learning abilities. We conducted an experiment in which field-collected individuals had to associate an unconditioned stimulus (sucrose) with a conditioned stimulus (coloured strip). We found that most species can learn to associate a colour with a reward, yet some do so better than others. These differences in learning were related to brain size: species with larger brains—both absolute and relative to body size—exhibited enhanced performance to learn the reward-colour association. Our finding highlights the functional significance of brain size in insects, filling a major gap in our understanding of brain evolution and opening new opportunities for future research.

Wild Progenitor and Landraces Led Genetic Gain in the Modern-Day Maize (Zea mays L.)

Maize (Zea mays ssp. mays) originated from Mexico and Central America and grew worldwide for food, feed and industrial products components. It possesses ten chromosomes with a genome size of 2.3 gigabases. Teosinte (Z. mays ssp. parviglumis) is the probable progenitor of the modern-day maize. The maize domestication favored standing gain of function and regulatory variations acquired the convergent phenotypes. The genomic loci teosinte branched 1 (tb1) and teosinte glume architecture 1 (tga1) played a central role in transforming teosinte to modern-day maize. Under domestication and crop improvement, only 2% (~1200) genes were undergone selection, out of ~60000 genes. Around ~98% of the genes have not experienced selection; there is enormous variation present in the diverse inbred lines that can be potentially utilized to identify QTLs and crop improvement through plant breeding. The genomic resources of wild relatives and landraces harbor the unexplored genes/alleles for biotic/abiotic tolerance, productivity and nutritional quality. The human-made evolution led to the transformation of wild relatives/landraces to the modern-day maize. This chapter summarized the maize’s wild relatives/landraces and the genetic gain over time in biotic/abiotic, productivity, and nutritional quality traits.

Citation Metrics in Psychological Science

We present norms for faculty citation counts based on 811 faculty members at 30 PhD-granting psychology departments in the United States across the range of the National Research Council rankings. The metrics were highly skewed, with most scientists having a low to moderate number of citations of their work and a few scientists having extremely high numbers. However, the median per-year citation count was 149, showing widespread scientific contributions across scholars. Some individuals in lower ranked departments are more highly cited than the average scholar in higher ranked departments, with enormous variation in citation counts in both the low- and high-ranking departments. Citation counts overall have risen in recent years, and the citations of early-career scholars are increasing at a faster rate than their senior colleagues did at the same point in their careers. We found that citation counts at the beginning of scientists’ careers substantially predict lifetime citation success. Young scholars’ citation counts are associated with obtaining positions at higher ranked universities. Finally, we found no significant differences for subfields of psychology. In sum, although a few highly productive scientists have a very large influence, trends reveal that contributions to psychological science are growing over time, widespread, and not limited to a few stars and elite departments.

Building Governance Capacity in Areas of Limited Statehood

Areas of limited statehood where central government authorities lack the capacity of implementing and enforcing decisions and/or lack the monopoly over the means of violence, are ubiquitous. However, these areas are neither ungovernable nor ungoverned. Enormous variation exists, that includes badly governed places but also “good governance” in areas of limited statehood, sometimes separated only by a few blocks. Effective governance (public service provision, rule-making) depends on three factors: legitimacy; social trust relations within communities; and adequate design of institutions, including financial resources. International Financial Institutions (IFIs) should thus focus on building governance capacity rather than further engaging in state-building, which has failed despite substantial investments. If the central state is autocratic and/or predatory, building state capacity will only make a bad situation worse. Yet, if the central government is constrained by the rule of law and by democratic institutions, but lacks the capacity to implement and enforce decisions, then capacity-building might help improve governance.

Conclusion

By roughly 1825 (the date of the publication of Sir Thomas Strange’s Elements of Hindu Law), the courts of the Bengal, Bombay, and Madras Presidencies enforced Colebrooke’s system of schools of Hindu personal law with the assistance of native Paṇḍitas.1 This system involved enormous variation. A Hindu family who moved from one region to another would remain under the jurisdiction of the school of law of their place of origin. Furthermore, the various schools of Hindu law were enforced differently in the Bengal, Bombay, and Madras Presidencies....

Optimising Seniors’ Metabolism of Medications and Avoiding Adverse Drug Events Using Data on How Metabolism by Their P450 Enzymes Varies with Ancestry and Drug–Drug and Drug–Drug–Gene Interactions

Many individuals ≥65 have multiple illnesses and polypharmacy. Primary care physicians prescribe >70% of their medications and renew specialists’ prescriptions. Seventy-five percent of all medications are metabolised by P450 cytochrome enzymes. This article provides unique detailed tables how to avoid adverse drug events and optimise prescribing based on two key databases. DrugBank is a detailed database of 13,000 medications and both the P450 and other complex pathways that metabolise them. The Flockhart Tables are detailed lists of the P450 enzymes and also include all the medications which inhibit or induce metabolism by P450 cytochrome enzymes, which can result in undertreatment, overtreatment, or potentially toxic levels. Humans have used medications for a few decades and these enzymes have not been subject to evolutionary pressure. Thus, there is enormous variation in enzymatic functioning and by ancestry. Differences for ancestry groups in genetic metabolism based on a worldwide meta-analysis are discussed and this article provides advice how to prescribe for individuals of different ancestry. Prescribing advice from two key organisations, the Dutch Pharmacogenetics Working Group and the Clinical Pharmacogenetics Implementation Consortium is summarised. Currently, detailed pharmacogenomic advice is only available in some specialist clinics in major hospitals. However, this article provides detailed pharmacogenomic advice for primary care and other physicians and also physicians working in rural and remote areas worldwide. Physicians could quickly search the tables for the medications they intend to prescribe.