17A - Medicine and Biochemistry University of Warwick and Monash University Australia
General sonographic practice in Thailand is undergoing major reform. Previously, comprehensive sonographic examinations – performed by sonographers in Australia – were undertaken by radiologists. Ultrasound imaging was expensive, rurally inaccessible, and strained the radiologist workforce. A postgraduate program formed in collaboration with Monash University was created to address these issues.
This research, carried out between Dec 10-21 2018, aimed to examine the necessity, pedagogical method, outcomes of this program and scope of practice of sonographers in Thailand. The inaugural class of three students, their program coordinators and instructors were observed delivering the program on-site in Bangkok. Anecdotal evidence was collected through informal, non participant observation and interviews, with data used to formulate a reflective journal. The collected data forms the basis of a fourth year capstone research paper being written and developed in 2019.
Onsite in Bangkok, didactic, Thai-English lectures and scanning workshops provided clinical knowledge for program participants. Student sonographers performed preliminary comprehensive exams, with physicians reviewing and rescanning abnormal ultrasound appearances. The primary challenges appeared to be selection and dissemination of graduates into rural areas, and workplace adjustment to the shifting sonographer role.
The current paper informed by these findings is being developed in conjunction with an international professional body, the International Society of Radiographers and Radiological Technologists (ISRRT). It is an ethically approved survey examining the scope of practice for sonographers worldwide, and its impact upon global standards of practice.
Background: In 2016, Higher Education England reported a 24% decline from 74% of FY2 doctors entering higher training over five years with an increasing proportion taking a career break from medicine.  General and Vascular Surgery ST3 posts experienced the lowest fill rate at 86.5% compared to 100% in previous years.  Two systematic reviews on factors dissuading a surgical career highlighted poor work-life balance, limited theatre exposure and gender discrimination. [3,4]
Aim: Cross-sectional study aimed at exploring factors affecting surgical career choice, career aspirations and confidence levels in managing surgical presentations at a UK-based medical school.
Method: Fifty-eight medical students from Warwick Medical School attended a one-day course organised by foundation doctors involving case-based discussions, simulated post-operative complications and surgical skills. Candidates consented to complete pre- and post-course questionnaires on career aspirations, deterring and promoting factors to a surgical career and confidence levels on six surgical presentations.
Results: Theatre experiences were most memorable with 65.1% observing and 32.6% assisting. Poor work-life balance was the major deterrent (58.8%) followed by high competition rates (27%). The ratio of pre- and post-course career preference was not statistically different (0.41, p=0.991). Confidence levels increased in all six surgical case presentations.
Discussion: Approximately 25% of this cohort were interested in pursuing a career in surgery, a majority of which were women. Poor work-life balance was the major deterrent (58.8%) followed by high competition rates (35.3%). Facilitating hands-on theatre exposure for medical students and junior doctors may tackle declining recruitment rates.
The research is based on the inheritance of adaptive maternal effects through the germ-line. This is based on the trauma experienced by the parental generation that can cause the transmission of psychiatric diseases to the offspring. However, little is known about how neuronal activity results in diseased offspring. A new model system, which will allow the easy monitoring of how environmental stress affects neuronal activity and induction of visible characteristics in the offspring will be used. The hypothesis is that the environment of the mother Auanema freiburgensis (roundworm) determines the type of offspring produced. Under normal conditions, the mother produces stress-susceptible progeny. However, when the mother is stressed, she produces stress-resistant offspring. In this project, a variety of candidate chemicals will be experimented on the roundworms to disrupt neuronal signalling to identify chemicals that are involved in the production of stress-resistant offspring. Alternatively, modern genome-editing technologies (CRISPR-Cas9) will be used to disrupt candidate genes involved in this process. These offspring are easy to distinguish because of their shape and colour. These data indicate that an environmental signal is detected by neurons, which transmit the information to the germline. The goal of the project will be to test candidate molecules that mediate the transmission of information between the neurons and the germline. Since there is an international community of researchers examining roundworms as model organisms for physiological study, the data obtained in this project may be used as pilot results and may add to the existing knowledge base.
Recurrent Pregnancy Loss (RPL) affects 1-2% of women of reproductive age. Unfortunately, around half of these cases remain unexplained. Women with Diminished Ovarian Reserve (DOR) are suggested to be at increased risk of RPL. Therefore Ovarian Reserve Tests (ORTs), used as an investigative tool in women with RPL, have the potential to optimise targeted patient care.
Objective: This systematic review and meta-analysis aims to evaluate the association between DOR, as measured by ORTs, and RPL.
Method: We searched MEDLINE, EMBASE, Web of Science and Scopus from inception until May 2019 for all studies evaluating static ORTs measured in women with unexplained-RPL (URPL) compared to non-RPL or explained-RPL (ERPL) controls. Screening, data extraction and quality assessment were undertaken by two independent reviewers.
Results: Fifteen studies were analysed reporting on 3,082 women and six ORTs. Six studies reporting five ORTs were included in meta-analyses. There was a significant association between DOR and RPL, as measured by low Anti-Mullerian Hormone (AMH) levels (OR=2.77[1.41 ,5.46], p=0.03, I2=0%) and Antral Follicle Count (AFC) (OR=2.45[1.16, 5.19], p=0.02, I2=59%), when compared to non-RPL women. Women with URPL were significantly more likely to have DOR, as measured by AMH levels (OR=3.23[1.81, 5.76], p<0.0001, I2=0%), when compared to women with RPL of known aetiology. No differences were found in the remaining ORTs; Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH), Oestradiol and FSH:LH ratio.
Conclusions: This systematic review demonstrates that there is a significant association between DOR and RPL, as measured by low AMH levels and AFC.
17D - Cultures of Hospitality University of Warwick and Nanyang Technological University
The purpose of this research is to study the social environment in Japan, in particular, the insider-outsider cultural dialectic of this Asian country known for its ritualised and scripted politeness. In Japan, the label “haafu” (half-Japanese) and its derogatory connotations suggest a general aversion for things not purely Japanese. This research examines Japan’s history as an agrarian society, compares Japan with the Western countries and explores how this insider-outsider culture may impact Japan’s future. The methodology of this research entails surveying and reviewing works of prominent nihonjinron analysts and critical writers, collecting newspaper articles on Japanese society, interviewing Japanese living in Singapore and non-Japanese in Japan. From this research, it was found that Japan’s early days as an agrarian society contributed to “groupism” behaviours, which, as an important part of history, has legitimated the value of homogeneity, relevant even today. Throughout the course of Japanese history, comparisons with countries perceived to be superior to Japan has seen multiple phases, with the current focus of comparison being America. Moreover, as a characteristic of the rigid formalities, superior-subordinate relations and other formalised or institutionalised power and social relations continue to be taken seriously. From these findings it can be concluded that the insider-outsider culture of Japan will persist, albeit less strongly compared to the past due to modernisation and globalisation. It must also be noted that although Japan is not the only country with a disinclination to “outsiders”, it remains a very suitable context for such research due to its past.
Undergraduate research (UR) can be a powerful institutional tool for transforming the undergraduate experience for all students. Theoretical work and empirical findings in the literature inform that through UR, students can be integrated into communities of academic practice and develop researcher identities that help them navigate each stage of the higher education lifecycle. As a form of inquiry-based learning, UR presents a unique opportunity for refashioning the role of undergraduate students from passive consumers to partners in the production of knowledge. However, there are barriers that students face to participating in UR.
Drawing from Warwick's undergraduate population, we conducted a survey, focus groups and interviews to determine undergraduate students' perceptions and experiences of undergraduate research. This presentation shares our findings to explore some of the barriers faced by students and to highlight the opportunities available for using UR as an enrichment tool. Building on our literature reviews and primary data, we argue that effective supervision allocations, more intra- and extra-curricular research opportunities and greater dissemination of these opportunities are integral to improving students' qualitative experiences of UR. Our thesis is that this would positively affect academic engagement, retention and educational outcomes, particularly for students from underrepresented backgrounds.
The implications of our research are relevant to Warwick and beyond; UR embodies the type of learning that can empower students to engage in the original and diverse thinking needed for addressing contemporary global challenges. Ultimately, our presentation encourages discussion of how we can create inclusive cultures of UR to facilitate this.
Some molecules are large enough to have spaces in which smaller molecules can bind to the internal surface. The latter are called guest molecules and typically bind through a single atom. My research investigates where the guest molecule, unusually, can bond through two atoms. The question here is how the relative positions of the two atoms affect secure binding to the cage.
To investigate the type of binding taking place, isomers of the same guest molecule can be used. This is where the guest molecule has the same atoms but arranged in a different structure. Whether or not a specific isomer can bind to the internal surface and the strength of the binding can be measured through fluorescence titrations. By shining a light at the cage, it will release light in response. As more guest binds in the cage, less light can be released which can be measured and used to calculate the binding constant, a measure of the strength of binding. The hypothesis is that only one specific isomer of the guest molecule will bind strongly within the cage shown by the largest binding constant.
The conclusions from this research have the potential for many applications including purification of mixtures and catalysis. The rigid two-site binding of the guest molecule could provide more selective conditions for catalytic reactions to take place. This would reduce waste and the number of steps to purify the product. Ultimately, the insights of the research could lead to cleaner chemical processes and reduce pollution.
The Greeks of the Archaic period (800-479 B.C.) believed that gods roamed towns posing as strangers to test people’s faith and morality. Although the incentive of divine punishment may have helped to reinforce the establishment of hospitality as a custom, it does not offer a plausible justification to the custom’s necessity (J. Pitt-Rivers, 1977). Thus, this presentation aims to identify the reason(s) hospitality became a necessity during the Archaic period. Understanding the above could lead to a deeper understanding of the socio-political institutions preceding our own.
The research is methodologically based on questioning the following hypotheses: (1) Hospitality became necessary because traveling and communication was difficult, (2) Hospitality was needed as a method of protection and informal border control. Subsequently, primary and secondary sources will be consulted to test the validity of the above hypotheses.
Wishing to capture the mentality of the era, the main primary sources utilized will be Homer’s Iliad and Odyssey. Although partially fictitious, they offer valuable insights into their contemporary’s daily life. Their validity as sources is confirmed through the works of the Greek storyteller and, often cited as “Father of History,” Herodotus, and the historian Thucydides, who lived during the Classical period (579-323 B.C.). Their works are also invaluable as sources, given that attitudes linked to the above hypotheses did not change dramatically through the years. Proof comprises Plato’s (427-348 B.C.) characterization of Homer as the poet who “educated Greece” (Republic 606e1–5.
17F - Decision Making in Health University of Warwick and Nanyang Technological University
Human papillomavirus (HPV) is a primary cause of cervical cancer, which affects women globally. There has been much research conducted to find out the motivations behind an individual’s intention of taking up the HPV vaccination, but few are focused on the parents’ decision-making process to vaccinate their daughters against HPV. Moreover, not much research is done in the Asian context, specifically in Singapore. As such, the Theory of Planned Behaviour (TPB) model is used in this study to find out the underlying reasons why mothers decide for their daughters to take up the HPV vaccine in Singapore. In-depth interviews were conducted with 20 Singaporean mothers who have daughters aged between 9 and 26 years old for this research. Results showed that one of the main reasons for the low uptake of the vaccine was because the mothers do not believe in the effectiveness of the vaccine. Due to the vaccine’s novelty and its possible unknown side effects, they have a negative attitude towards the HPV vaccine. Moreover, since their daughters are not sexually active, the vaccine seems unnecessary to them. Together with the high cost of the HPV vaccine and the multiple trips needed to bring their daughters to take the vaccines, the mothers are reluctant to fork out the time and money to spend on the vaccine for their daughters. Therefore, the results suggest a need for intervention strategies to improve the attitudes of mothers towards HPV vaccination in order to encourage their daughters to take up the vaccine.
Amidst MeToo movements around the world and increased awareness of sexuality issues, the spotlight has been turned to sexuality education. This paper provides a comparative study of sexuality education in two countries in the Asia-Pacific – Australia and Singapore. Through a qualitative analysis of the sexuality education of the two countries, the similarities and differences of approaches, content, embedded ideological beliefs and theoretical frameworks are examined. Sexuality education is situated in the interplay of competing cultural, historical and political contexts. Thus, an analysis of key socio-political events, political climate and history is conducted to situate sexuality curriculum in different contexts. This paper argues that differences in political, historical and cultural values among these countries sets the foundation of ideological beliefs and frameworks in sexuality education. The paper contrasts Singapore’s Abstinence-Only approach with Australia’s Comprehensive Sex Education approach. It explores how the former, founded on Confucian values alongside economic rationality is contrasted against the latter, embedded in more liberal values. The political environment of these countries has also impacted the ability to augment change. While Singapore’s competitive state-managed political regime impedes citizenry participation in the sexuality education, Australia’s sexuality education has been marked by shifts due to pressure from active civil society. This paper offers a detailed and comprehensive understanding of sexuality education through a comparison of the two countries. It contributes to the literature on sexuality education by tracing the development of sexuality education in relation to different socio-political and historical factors of Australia and Singapore.
Background: Sports-related concussion (SRC) is a traumatically induced brain injury, brought on by biomechanical forces, resulting in a functional disturbance. The incidence of SRC in rugby has been rising steadily over the last decade. A large proportion of amateur players participate at school and university, with a growing number of them being female.
Aims: To evaluate the concussion experience, knowledge and attitudes of university rugby players in the UK.
Methods: A cross-sectional study was used where 234 university rugby union players (71% female; 28% male) from 52 UK universities completed a questionnaire.
Results: 46% would continue playing an important game if concussed and 24% would return to play whilst still experiencing concussive symptoms despite 98% knowing they should not do so. 92% of participants identified true symptoms of concussion correctly. 63% reported previous history of serious head injury, of which, 73% were removed from play. There was little variation of attitudes and knowledge between gender.
Conclusion: There was a clear discrepancy between concussion knowledge and player attitudes. Athletes may continue to engage in unsafe playing behaviour despite possessing awareness of the long-term effects and symptoms of concussion. The Concussion in Sport Group (CISG) have encouraged schools to put “return-to-learn” guidelines in place for students to safely return to the classroom following an SRC. Yet, there is an apparent lack of such practices for adults within further education. Though current concussion education programmes, such as Headcase, seem to have been somewhat successful, a multidimensional approach should be adopted to facilitate attitudinal and behavioural change.
The National Institute for Health and Care Excellence (NICE) outlines that patients who present to accident and emergency departments and minor injuries units should be provided with high quality written information upon discharge. This information is to ensure that symptoms which could result from serious complications are picked up quickly and other benign symptoms are managed and supported at home. This research surveyed departments across the UK to assess whether information was provided and the quality of this information. Overall, the quality is poor across all four nations in the UK, and this puts the health and well-being of patients at considerable risk. The accessibility for patients with visual impairments and older patients is poor, with frequent reccomendations and referrals to online resources. There is significant opportunity to improve patient care, based on the evidence of the guidelines and this research. Significantly, there should be a move towards standardised information, used by all departments, to ensure quality and accessibility.