Ken Donald

Climatic variables and transmission of malaria: A 12-year data analysis in Shuchen County, China

OBJECTIVE The objective of this study was to explore the impact of climate variability on the transmission of malaria, a vector-borne disease, in a county of China and provide suggestions to similar regions for disease prevention. METHODS A time-series analysis was conducted using data on monthly climatic variables and monthly incidence of malaria in Shuchen County, China, for the period 1980-1991. RESULTS Spearmans correlation analysis showed that monthly mean maximum and minimum temperatures, two measures of monthly mean relative humidity, and monthly amount of precipitation were positively correlated with the monthly incidence of malaria in the county. Regression analysis suggested that monthly mean minimum temperature and total monthly rainfall, with a one-month lagged effect, were significant climatic variables in the transmission of malaria in Shuchen County. Seasonality was also significant in the regression model and there was a declining secular trend in the incidence of malaria. CONCLUSION The results indicate that climatic variables should be considered as possible predictors for regions with similar geographic, climatic, and socioeconomic conditions to those of Shuchen County.

Climate variability and Ross River virus transmission.

Objectives: (1) To examine the feasibility to link climate data with monthly incidence of Ross River virus (RRv). (2) To assess the impact of climate variability on the RRv transmission. Design: An ecological time series analysis was performed on the data collected between 1985 to 1996 in Queensland, Australia. Methods: Information on the notified RRv cases was obtained from the Queensland Department of Health. Climate and population data were supplied by the Australian Bureau of Meteorology and the Australian Bureau of Statistics, respectively. Spearmans rank correlation analyses were performed to examine the relation between climate variability and the monthly incidence of notified RRv infections. The autoregressive integrated moving average (ARIMA) model was used to perform a time series analysis. As maximum and minimum temperatures were highly correlated with each other (rs=0.75), two separate models were developed. Results: For the eight major cities in Queensland, the climate-RRv correlation coefficients were in the range of 0.12 to 0.52 for maximum and minimum temperatures, -0.10 to 0.46 for rainfall, and 0.11 to 0.52 for relative humidity and high tide. For the whole State, rainfall (partial regression coefficient: 0.017 (95% confidence intervals 0.009 to 0.025) in Model I and 0.018 (0.010 to 0.026) in Model II), and high tidal level (0.030 (0.006 to 0.054) in Model I and 0.029 (0.005 to 0.053) in Model II) seemed to have played significant parts in the transmission of RRv in Queensland. Maximum temperature was also marginally significantly associated with the incidence of RRv infection. Conclusion: Rainfall, temperature, and tidal levels may be important environmental determinants in the transmission cycles of RRv disease.

Climate Variability and Transmission of Japanese Encephalitis in Eastern China

A time-series analysis was conducted to study the impact of climate variability on the transmission of Japanese encephalitis in eastern China. Correlation and regression analyses were used to examine the relationship between monthly climatic variables and monthly incidence of Japanese encephalitis in Jieshou County, China over the period 1980-96. Spearmans correlation analysis showed that maximum and minimum temperatures and rainfall were all associated with the transmission of Japanese encephalitis in the county. Regression analysis suggested that monthly mean minimum temperature and monthly precipitation had a significant relationship with the transmission of Japanese encephalitis, with a 1-month lag effect. The results indicated that these climatic variables might be treated as possible predictors for regions with similar geographic, climatic, and socio-economic conditions to Jieshou County.

Medical schools—do they add value?

The global medical workforce currently poses complex issues around supply and demand, quality and safety, rapidly changing practises following explosions in knowledge with needs for new skills and significant impacts from information technology and an increasingly well-informed population. Traditional national borders are becoming highly permeable as a result of extensive physician migration and developments in E-Medicine. In the medical workforce the age of ‘the global village’ is well established. The medical student pipeline is fundamental to keeping the complex adaptive system that is health services on track. In the current issue Boulet et al. argue that more should be known about the world’s medical school collective and they provide a useful description based on currently available data. Those data show many mismatches nationally between supply and demand as well as a rapid increase in the number of medical schools globally. They are silent on quality. Medical schools do more for a health system than simply supply the junior doctor pipeline. They play key roles in research, postgraduate training and setting practice standards. The content of medical courses world wide is largely the same with some variation in emphasis on particular disease patterns in different regions. It is the other activities of medical schools that really decide the quality of their graduates, e.g. mentoring, understanding of the role of research, role modelling, ethical lifelong professional development, communication and socialising skills and technical skills development. The worldwide recognition that quality and safety in health services could be significantly improved poses a challenge for medical schools amongst others. The implications of all of this are that medical schools need to play a well structured and preferably coordinated role in the global supply and quality of the medical workforce. Clinical academic medicine is currently going through changes that do not have a clear direction. Countries are struggling with registration of externally trained physicians. Traditionally medical schools have each seen themselves as unique. They are, though not in the content of their program but, rather, in the staff–student interaction referred to above. Is there a case, as suggested by Boulet et al., for better information regarding the quantity and quality of the medical workforce pipeline? In the face of the globalisation of physician migration, e-health and concerns about the quality and safety of health systems everywhere and the questions over the future structure of clinical academic medicine the answer surely is ‘yes’. Individual governments will do their own thing about supply and accreditation. Is there a role for the global medical school collective to value add to such local action? The publication of the article by Boulet et al. suggests that the Editorial Board of the journal sees this as a significant issue. Perhaps an influential group such as the Board could take up the issue on a global front. An argument can be raised that the medical education community is the only group that can advocate for this issue effectively and develop a proactive position. Not to do so could result in significant loss of influence by medical schools in the global development of supply and quality of the medical workforce.

Southern Oscillation Index and transmission of the Barmah Forest virus infection in Queensland, Australia

El Nino-Southern Oscillation (ENSO) events are usually accompanied by changes in the trade winds, cloud amounts and rainfall over the tropical Pacific and Australian regions,and seem to be related to many climatic anomalies around the globe. A measure of ENSO is the Southern Oscillation Index (SOI),which is the normalised atmospheric pressure diVerence between Tahiti in the south Pacific and Darwin in northern Australia. The SOI is closely related to variations in temperature and rainfall across the Pacific and in eastern Australia. 1

Carcinoid tumour of the thymus

This report concerns a 49 year old asymptomatic male who had a mediastinal mass demonstrated on routine radiography. A large encapsulated tumour composed of small regular cells arranged in clumps and acini with fine vascular stroma was removed. The differential diagnosis on routine H&E section included parathyroid tumor, medullary carcinoma arising in ectopic thyroid tissue, epithelial thymoma or carcinoid tumor of the thymus. The presence of compressed thymic tissue around the tumor, and of argentaffin granules together with the electron microscopic appearance characteristic of the “enterochromaffin” or “APUD” group of cells allowed the diagnosis of carcinoid tumor of the thymus to be made. Electron microscopy showed that the cell cytoplasm contained electron dense membrane bound granules, together with bundles of microfilaments. Vesicles of smooth surfaced reticulum were present but rough surfaced reticulum was inconspicuous. No desmosomes were demonstrated. Special stains for amyloid and glycogen were negative.

Using a structured clinical coaching program to improve clinical skills training and assessment, as well as teachers' and students' satisfaction.

Introduction: The ability to deliver the traditional apprenticeship method of teaching clinical skills is becoming increasingly more difficult as a result of greater demands in health care delivery, increasing student numbers and changing medical curricula. Serious consequences globally include: students not covering all elements of clinical skills curricula; insufficient opportunity to practise clinical skills; and increasing reports of graduates’ incompetence in some clinical skills. Methods: A systematic Structured Clinical Coaching Program (SCCP) for a large cohort of Year 1 students was developed, providing explicit learning objectives for both students and paid generalist clinical tutors. It incorporated ongoing multi-source formative assessment and was evaluated using a case-study methodology, a control-group design, and comparison of formative assessment scores with summative Objective Structured Clinical Examination (OSCE) scores. Results: Students demonstrated a higher level of competence and confidence, and the formative assessment scores correlated with the Research students’ summative OSCE scores. SCCP tutors reported greater satisfaction and confidence through knowing what they were meant to teach. At-risk students were identified early and remediated. Discussion: The SCCP ensures consistent quality in the teaching and assessment of all relevant clinical skills of all students, despite large numbers. It improves student and teacher confidence and satisfaction, ensures clinical skills competence, and could replace costly OSCEs.

Fibrin-Bound Tumour Cells on a Sclerosed Mitral Valve

Summary The association of fibrin and tumour cells on a sclerosed mitral valve in a 62‐year‐old woman is described. This was the first indication of malignant disease but bilateral ovarian cancer was proved two months later. No further tumour deposits have been found in fifteen months. The tumour deposit on the valve was most likely a metastasis but primary heart valve sarcoma has not been positively excluded. If the lesion was a secondary deposit this has possible implications for the role of fibrin in metastasis in humans.