THE WORSLEY TIMES

Author: Worsley Times

  • Running Towards Academic Success

    Running Towards Academic Success

    Katie Webb, Year 3

    Sport and PE make up an important part of school curriculums. But how beneficial are these subjects in the pursuit of academic success?

    Many children give up playing sports as they approach important school exams – but is this beneficial? In short, no. A study in 2019 suggested that playing sport is positively associated with mental toughness and psychological wellbeing and that there is a small association between playing sport and academic achievement (Moxon et al, 2019). Other studies have also shown a considerable association between schools producing successful sporting teams with higher academic achievement and graduation rates, and crucially found that in schools with similar demographics and funding, those with larger sports programmes fared better academically (Bowen and Greene, 2012). Interestingly, one study found that even if an hour per day was taken from other subjects to increase the time spent on physical activity in primary schools, academic results improved, and equally if PE time was reduced, there was no benefit to academic achievement (Montecalbo-Ignacio, Ignacio and Buot 2017). It is therefore reasonable to accept that there is an association to sports participation and achievement and academic achievement. But the interesting question is why.

    There is much evidence that exercise improves cognitive performance and memory, and therefore it is not unreasonable to suggest that general academic performance might also be improved by these factors (Di Liegro et al, 2019). The biochemical interactions underpinning it are not fully understood but the resulting increase in grey matter in the frontal and hippocampal regions (Colcombe et al, 2006) (Erikson et al 2011), as well as the upregulation of the release of neurotrophic factor (Coelho et al, 2013), is well recognised. Therefore, one argument to explain the link between academic performance and sport is simply a neuroscientific one.

    It could also be argued that sport develops characteristics that enable academic success. Regular aerobic exercise is associated with greater resilience to stress), improved self-esteem and higher levels of general wellbeing (Nowacka-Chmielewska et al, 2022) (Eime et al 2013) (Steptoe and Butler, 1996). It is very plausible that these are mediating factors that result in improved academic performance. That is, that the psychosocial skills gained from sport and exercise overlap with those required for academic success.

    There is also an argument that the link is simply correlation rather than causation. Simply consider a confounding factor such as socioeconomic status, which is associated both with exercise level (Federico et al, 2013) and academic performance (Brooks-Gunn and Duncan, 1997). In other words, that someone a higher socioeconomic status is likely to increase academic performance and sport participation independently. It is not hard to imagine a situation where a child is born into a well-off family and has numerous opportunities to compete in sport as well as resources and tutoring to succeed academically. However, as discussed earlier (Bowen and Greene, 2012), even those studies that control for factors such as school demographic and funding, there appears to be an association between sports and academic achievement. 

    Like most things in life, the reason for this link is likely to be multifactorial. The chances are, if you take up running you won’t instantly turn into Einstein, but it is also unlikely to have a negative effect on your academic success. Be it as the result of biochemical reactions or the development of psychological and social skills, or some other reason, this surely must play into educational planning. Set against the context of huge academic uncertainty, and likely entering yet more years of government austerity, it is likely that schools, universities and workplaces will be cutting budgets wherever they can. In times like these, it’s typically subjects like maths, English and science that get focussed on at the expense of subjects like PE and music. Let’s hope they listen to the science and know that cutting time spent on sport is unlikely to yield any better academic results. 

    References:

    Bowen, D.H., & Greene, J.P. (2012). Does Athletic Success Come at the Expense of Academic Success. Journal of Research in Education, 22, 2-23.

    Brooks-Gunn, J., & Duncan, G. J. (1997). The effects of poverty on children. The Future of children, 7(2), 55–71.

    Bruno Federico, Lavinia Falese, Diego Marandola & Giovanni Capelli (2013) Socioeconomic differences in sport and physical activity among Italian adults, Journal of Sports Sciences, 31:4, 451-458, DOI: 10.1080/02640414.2012.736630

    Coelho, F. G., Gobbi, S., Andreatto, C. A., Corazza, D. I., Pedroso, R. V., & Santos-Galduróz, R. F. (2013). Physical exercise modulates peripheral levels of brain-derived neurotrophic factor (BDNF): a systematic review of experimental studies in the elderly. Archives of gerontology and geriatrics, 56(1), 10–15. https://doi.org/10.1016/j.archger.2012.06.003

    Colcombe, S. J., Erickson, K. I., Scalf, P. E., Kim, J. S., Prakash, R., McAuley, E., Elavsky, S., Marquez, D. X., Hu, L., & Kramer, A. F. (2006). Aerobic exercise training increases brain volume in aging humans. The journals of gerontology. Series A, Biological sciences and medical sciences, 61(11), 1166–1170. https://doi.org/10.1093/gerona/61.11.1166

    Di Liegro, C. M., Schiera, G., Proia, P., & Di Liegro, I. (2019). Physical Activity and Brain Health. Genes, 10(9), 720. https://doi.org/10.3390/genes10090720

    Eime, R. M., Young, J. A., Harvey, J. T., Charity, M. J., & Payne, W. R. (2013). A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport. The international journal of behavioral nutrition and physical activity, 10, 98. https://doi.org/10.1186/1479-5868-10-98

    Erickson, K. I., Voss, M. W., Prakash, R. S., Basak, C., Szabo, A., Chaddock, L., Kim, J. S., Heo, S., Alves, H., White, S. M., Wojcicki, T. R., Mailey, E., Vieira, V. J., Martin, S. A., Pence, B. D., Woods, J. A., McAuley, E., & Kramer, A. F. (2011). Exercise training increases size of hippocampus and improves memory. Proceedings of the National Academy of Sciences of the United States of America, 108(7), 3017–3022. https://doi.org/10.1073/pnas.1015950108

    Montecalbo-Ignacio, R.C., Ignacio, R.A., & Buot, M.M. (2017). Academic Achievement as Influenced by Sports Participation in Selected Universities in the Philippines. Education 3-13, 7, 53-57.

    Moxon, P., Clough, P., Dagnall, N., Clough, E., & Elstone, D. (2019). The potential benefits and costs of participation in school sport. Physical Education Matters, (Autumn 2019), 26-28.

    Nowacka-Chmielewska M, Grabowska K, Grabowski M, Meybohm P, Burek M, Małecki A. Running from Stress: Neurobiological Mechanisms of Exercise-Induced Stress Resilience. Int J Mol Sci. 2022 Nov 1;23(21):13348. doi: 10.3390/ijms232113348. PMID: 36362131; PMCID: PMC9654650.
    Steptoe, A., & Butler, N. (1996). Sports participation and emotional wellbeing in adolescents. Lancet (London, England), 347(9018), 1789–1792. https://doi.org/10.1016/s0140-6736(96)91616-5

  • The Dementia Gap – Why Are Women at Greater Risk of Developing Alzheimer’s Disease and Other Forms of Dementia?

    The Dementia Gap – Why Are Women at Greater Risk of Developing Alzheimer’s Disease and Other Forms of Dementia?

    Paulina Szlendak, Year 3

    According to astounding statistics by alzheimers.org.uk, women with dementia outnumber men 2 to 1 worldwide. What is the cause of such a drastic difference in prevalence? One common hypothesis is that, on average, women live longer than men, and therefore have more time to develop dementia, which is commonly associated with old age (Brinton et al., 2015). While risk does increase with age, the pathophysiology of dementia in relation to gender is much more complex than that. Current research suggests that looking at hormonal changes during menopause is the key to uncovering the mystery of this dementia gender gap (Mishra et al., 2022).

    Menopause is a natural stage of life experienced by half of the population worldwide. As of now, there are approximately 850 million women aged 40-60 years old who are likely to be going through or are already past menopause (US Census Bureau, 2014). The neuroendocrine transition of this process often manifests with numerous neurological symptoms: insomnia, depression, hot flashes and loss of cognitive sharpness (Brinton et al., 2015). Unfortunately, all these common symptoms of menopause have been identified as risk factors for dementia, especially Alzheimer’s Disease (AD) (Brinton et al., 2015).

    Before we look at why women are at a greater risk of developing dementia and AD, experts in the field of neurological ageing highlight an important change in perception of brain ageing. It was previously thought to be a linear process of steady decline in function, paired with a slow accumulation of toxic compounds. Only recently have scientists realised that ageing of the brain is in fact not linear at all, but a dynamic process. In the female brain there is an important catalyst of this process during midlife (Mishra et al., 2022). Recent studies looking at sex differences in AD development confirm that there are earlier neuro-degenerative changes occuring in female brains than male (Mielke et al., 2014). Moreover, these changes have been linked to the endocrine ageing process physiologically occurring in females during menopause (Mosconi et al., 2017).

    Mid-life ageing in women is characterised by three stages: 1) early chronological (pre-menopause), 2) endocrinological (menopause) and 3) late chronological (post-menopause) (Scheyer et al., 2018; Mishra et al., 2022). Throughout these steps there is a shift in the energy metabolism of the brain. Unlike a young brain, it stops relying exclusively on glucose, and switches to utilising lipids and ketone bodies (Mishra et al., 2022). It is thought that this change in fuel dependence to be more lipid-based puts the greatest store of fatty acids in the CNS – white matter – at risk of breakdown in order to produce ketones. Data from numerous studies on Alzheimer’s Disease point to endocrinological ageing as the critical ‘tipping point’, which could initiate the start of late-onset AD (Scheyer et al., 2018).

    You may ask: “How does it affect men, if the process is linked to endocrinological changes with menopause?”. Well, males with AD exhibit the same shifts in the brain’s energy metabolism, which lead to fuel deficits, immune system activation and progression of degenerative changes. The process shares pathological mechanisms in both sexes. However, in females the critical catalyst – decreased oestrogen control of glucose metabolism – in turn leads to increased risk of developing disease (Mishra et al., 2022). 

    It may seem a bit unfair, that a physiological hormonal transition predisposes women to developing such debilitating conditions as dementia. Despite the multiple dementia risk factors that women face as they near the menopause, there is hope in the brilliant scientists and doctors at the frontiers of dementia research. Moreover, evidence-based lifestyle advice is available to people, who want to decrease their risk of developing a neurodegenerative condition. Some of these practices include: preventing head trauma, limiting alcohol and smoking, managing neuropsychiatric disorders, and in some cases – managing menopause with Hormone Replacement Therapy – which tackles the key hormonal risk factor of dementia (Dementia prevention, intervention, and care: 2020 report of the Lancet Commission).

    References:

    Brinton RD, Yao J, Yin F, Mack WJ, Cadenas E. Perimenopause as a neurological transition state. Nat Rev Endocrinol. 2015 Jul;11(7):393-405. doi: 10.1038/nrendo.2015.82. Epub 2015 May 26. PMID: 26007613.

    Lisa Mosconi, Valentina Berti, Crystal Quinn, Pauline McHugh, Gabriella Petrongolo, Isabella Varsavsky, Ricardo S. Osorio, AlbertoPupi, Shankar Vallabhajosula, Richard S. Isaacson, Mony J. de Leon, Roberta Diaz Brinton

    Neurology Sep 2017, 89 (13) 1382-1390; DOI:10.1212/WNL.0000000000004425

    Scheyer, O., Rahman, A., Hristov, H. et al. Female Sex and Alzheimer’s Risk: The Menopause Connection. J Prev Alzheimers Dis 5, 225–230 (2018). https://doi.org/10.14283/jpad.2018.34

    Mielke MM, Vemuri P, Rocca WA. Clinical epidemiology of Alzheimer’s disease: assessing sex and gender differences. Clin Epidemiol. 2014 Jan 8;6:37-48. doi: 10.2147/CLEP.S37929. PMID: 24470773; PMCID: PMC3891487.

    Aarti Mishraa, Yiwei Wanga, Fei Yin, Francesca Vitali, Kathleen E.Rodgers, Maira Sotoa, LisaMosconi, Tian Wang, Roberta D. Brinton, Person Envelope et al. (2021) A tale of two systems: Lessons learned from female mid-life aging with implications for alzheimer’s prevention & treatment, Ageing Research Reviews. Elsevier. Available at: https://www.sciencedirect.com/science/article/pii/S1568163721002890?via%3Dihub (Accessed: January 8, 2023). 

    Dementia prevention, intervention, and care: 2020 report of the Lancet Commission: Gill Livingston, Jonathan Huntley, Andrew Sommerlad, David Ames, Clive Ballard, Sube Banerjee, Carol Brayne, Alistair Burns, Jiska Cohen-Mansfield, Claudia Cooper, Sergi G Costafreda, Amit Dias, Nick Fox, Laura N Gitlin, Robert Howard, Helen C Kales, Mika Kivimäki, Eric B Larson, Adesola Ogunniyi, Vasiliki Orgeta, Karen Ritchie, Kenneth Rockwood, Elizabeth L Sampson, Quincy Samus, Lon S Schneider, Geir Selbæk, Linda Teri, Naaheed Mukadam

  • Exactly Why the Junior Doctors Are Striking, And What We Can Do To Help

    Exactly Why the Junior Doctors Are Striking, And What We Can Do To Help

    Ahmad Zargar, Year 2

    I am only a second year but as deputy student representative to Leeds for the medical student committee of the BMA, I have heard my fair share of the complaints that I will soon share as I progress through the years of medical school. A prominent topic of discussion among the committee has been preparation for the anticipated strikes. The climate surrounding junior doctors’ working environment and their pay is worrying and quite frankly the numbers speak for themselves; the BMA has calculated that doctors have had a 26% pay cut in real terms in comparison to 2008 (BMA, 2022). 

    Chart, line chart Description automatically generated

    Figure 1: Real decline of pay awards for junior doctors in England (BMA, 2022)

    According to the BMA’s Junior Doctor committee (JDC) the government has not responded to the BMA’s request to even meet to discuss the issue at hand. 

    The JDC co-chairs responded strongly as they announced the start of a ballot to strike;

    “A junior doctor is not worth more than a quarter less today than they were in 2008.”

    This comes just before the Royal College of Nurses had announced that nurses intend to strike later this year, something doctors have expressed support for. Through a combination of this and the JDC’s decision to strike the situation within the NHS becomes evident. Thus, signifying that the issue doesn’t just stop at pay. If the government do not want to invest in skilled individuals, without whom the service would cease to exist, what does that say about the NHS’ resources as a whole? It suggests a reluctance to fund the NHS properly, which is especially apparent from the inside and ultimately culminated in its workforce having to take action. The years of underfunding has presented as a holistic issue. This is proven by the BMA’s council chair’s response to the RCN’s decision to strike; “Along with other frontline healthcare workers, nurses have borne the brunt of an understaffed and under-resourced health service… healthcare staff are too often unable to provide patients with the safe care they need.” (BMA, 2022a)

    Chart, histogram Description automatically generated

    Figure 2- (British Medical Association, 2022)

    Some of the shocking statistics coming out of the last year (Patterson, 2021) and (Palmer,2022):

    • Numbers of doctors leaving the NHS pension scheme – 50,000.
    • Numbers of doctors retiring early – trebled since 2008.
    • Current shortfall in medical workforce – 50,000.
    • Percentage of nurses actively planning to leave – 19%
    • Percentage of nurses thinking of leaving – 38%
    • Number of unfilled nursing roles – 47,000
    • Number of staff leaving in the year up to September 2021 – 140,000
    • Number of patients currently waiting for treatment – 7.1 million
    • Number of people waiting over a year for treatment – 400,000 (308x pre-COVID)

    (British Medical Association, 2022)

    Chart, line chart Description automatically generated

    Figure 3 -Annual selected NHS staff leaver rates (Palmer and Rolewicz, 2022)

    The ballot to strike for junior doctors will open on 9th January 2023, with ample time being given to allow for them to save up and prepare. In the meantime, the BMA are watching the government’s response to the RCN’s vote to strike as it is likely to have a similar response to doctors. 

    Steve Barclay, the current Health Secretary responded, “We also need to recognise that these are economically challenging times. We need a strong economy in order to pay for a strong healthcare system” alongside refuting the demands of the RCN’s desired pay rise as unaffordable. This comes in the same year where the government has pledged to increase annual military spending by £48 billion (Sabbagh, 2022). Looking back to the junior doctor strikes in 2016, the government were nonetheless reluctant to respond to strike action and public support of the strikes fell throughout its duration, despite being strong initially. It eventually took more than two years to negotiate a deal – the same one in dispute contemporarily. 

    The increased risk of patients dying preventable deaths with a lack of junior doctor presence is extremely high, raising an ethical dilemma and the question of who is to blame in these situations. What must ask ourselves, what if these unfortunate patients were to be one of our loved ones? However, it is easy to forget that there are two parties at the negotiation table, with the lack of government intervention making them equally worthy of blame. As the JDC proclaim “Strike action is always a last resort. No doctor wants to take industrial action, and this is, of course, still wholly avoidable if the Government commits to full pay restoration.”

    In the meantime, the co-chairs of the JDC have met with the GP committee and consultant committee who plan to meet with representatives from the Department of Health and Social care. 12,000 junior doctors have joined local WhatsApp strike groups. The BMA has pushed out guidance to doctors facing particular difficulties striking such as Visas being at risk or a lack of funding. A liaison with the RCN has been planned regionally and pizza and pay events are taking place. 

    What can we do to help? As the BMA reps we are already in contact with the Yorkshire Junior Doctor Committee and are at their service for whatever they require. We will also be informed by them of any change to our studies and future work. A Leeds strike support group chat has been made and if you would like to be added to it, contact us using the details below. The next step is the ballot, where at least 50% of members must vote with at least 40% of those must vote in favour to strike for it to be successful. Therefore, we must raise awareness where we can. A tip would be to follow @doctorsvote on Instagram as they are a useful source for medical students regarding this issue.

    If you would like to help in taking action or require help in general, contact the BMA reps on Instagram @bma_uol or email me at um21aaz@leeds.ac.uk 

    References

    BMA 2022a. BMA expresses solidarity with nursing colleagues as RCN announces strike ballot – BMA media centre – BMA. The British Medical Association is the trade union and professional body for doctors in the UK. [Online]. [Accessed 29 November 2022]. Available from: https://www.bma.org.uk/bma-media-centre/bma-expresses-solidarity-with-nursing-colleagues-as-rcn-announces-strike-ballot.

    BMA 2022b. The Real Terms (RPI) pay detriment Experienced by junior Doctors in England since 2008/09 [Online]. [Accessed 26 November 2022]. Available from: https://www.bma.org.uk/media/6134/bma-ia-pay-restoration-methodology-13-september-2022.pdf.

    British Medical Association 2022. NHS backlog data analysis. The British Medical Association is the trade union and professional body for doctors in the UK. [Online]. Available from: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis.

    Palmer, B. and Rolewicz, L. 2022. The long goodbye? Exploring rates of staff leaving the NHS and social care. The Nuffield Trust. [Online]. Available from: https://www.nuffieldtrust.org.uk/resource/the-long-goodbye-exploring-rates-of-staff-leaving-the-nhs-and-social-care.

    Patterson, C. 2021. Pensions inequity fuels doctor retention decline. The British Medical Association is the trade union and professional body for doctors in the UK. [Online]. Available from: https://www.bma.org.uk/news-and-opinion/pensions-inequity-fuels-doctor-retention-decline.Sabbagh, D. 2022. UK defence spending to double to £100bn by 2030, says minister. the Guardian. [Online]. Available from: https://www.theguardian.com/politics/2022/sep/25/uk-defence-spending-to-double-to-100m-by-2030-says-minister.

  • Peep Show Netflix Series Review

    Peep Show Netflix Series Review

    Shawn Wambari, Year 3

    The sad realisation hits, as you see the end credit scene roll of the Netflix series that you have been binging for the last week come to an end. The emotional attachment, roller coaster of feelings and heart thumping cliff-hangers is all over and you feel a space in your heart is now gone and you don’t know what to do. Well no need to fear, grab another drink and get ready for the next marathon. Released in the early 2000’s set in London is the unique first person show called peep show, interesting name right? It follows two immature, mid twenties men as they go through life with all of its ups and downs, mainly downs for them which is pleasantly amusing for the viewer. The first person view when the characters have conversations makes it seem that you are part of the ‘el dude brothers’ making it the ‘three amigos’, feeling the Mexican vibe? Depending on the viewer age this might either be unfortunately relatable or slightly concerning of the future outlook of being an adult. There’s heartbreak as the el-dude brothers try find their love partners whilst nearly reaching that peak goal they somehow always fall short. Whether you laugh, or even cry it’s a 9 season blockbuster worth every minute. And if you are an indie music fan, the soundtrack will be right up your alley, so tunes and laughter what else would you want?

  • Fool Proof Steps on How Not to Buy Your Dad Socks for Christmas

    Fool Proof Steps on How Not to Buy Your Dad Socks for Christmas

    Shawn Wambari, Year 3

    In every home there is a sock draw full of Christmas themed socks of times of old. Whether there is a comedic fat Santa stuck in a chimney or Rudolph the red nose… you get the picture. We have all seen them before and yet somehow we always get trapped into buying them year after year. How can we end this cyclical no longer funny, slightly concerning Christmas sock pattern? Well, firstly it would help not waiting till the 24th to start franticly rushing down the high street looking for a last minute gift. Yes! Surprisingly you can actually be organised and try sort it out a few weeks beforehand, it is possible! 

    Secondly, think about the presents you have already given him, because we all know the feeling of having to fake a smile and say thank you for something we already have multiple duplicates for. Now you are probably thinking, I have no idea, there’s nothing else I can get. No need to fear now is the time to start being creative and think outside the box. Take a moment and think, what are some of the hobbies your dad does. Is he sporty? A big foodie? Maybe a collector, and not a hoarder as other people rightly say. Once you have searched your soul and identified that burning passion, think about the things they already have related to that. Maybe they play tennis but their racket is literally on its final strings, maybe he likes a bit of baking on the weekend with his special-not so special, barely edible vanilla cupcakes. Whatever it might be, delve into it and explore the options there. Hopefully by this point you have at least an inkling into what to get. Now the magic starts, luckily for you amazon prime will save you a lot of hassle, time and to be honest having to leave your bed. However, in the spirit of Christmas and goodwill as you may have heard, it would be a good change to head down to your local high-street and explore the shops there. You might find a hidden gem or something that despite a 2.34 million hits on google, you wouldn’t have found anywhere else. Furthermore, by buying from a local shop you will also make a local shop owners Christmas and help them during this cost of living crisis, doesn’t that just warm your soul. So now picture the scene, Christmas morning, everyone around the fire, smiles and laughter and you anxiously wait as your dad opens his present to find… socks. 

  • Burnout

    Burnout

    Shruti Chawla, Intercalating

    TW: Sensitive topic with some personal anecdotes that some readers may find upsetting

    “ Losing the love for what I do”

    “Exhausting”

    “Overachieved, overworked, overwhelming”

    These anonymous quotes describe Burnout, not using the Maslach Burnout Inventory, but at a human level, specifically at a student level. 

    Approaching the end of my first intercalating term, I have taken some time to reflect on the variation in workload, skill set, and expectations compared to third year. What I realised, quite starkly, is that the trajectory I was on during third year (juggling placement, study, employment, and a social life) was ultimately going to lead to burnout. 

    It’s important to remember that this conclusion came from my personal reflections. 

    However, this ultimately led to a deeper dive into the concept of burnout, and its prevalence within medical students. 

    Burnout is defined as, “a state of physical and emotional exhaustion” according to mental health UK and is defined as a “workplace phenomenon”. There are three main symptoms as defined by WHO:

    • Feelings of energy depletion 
    • Increased mental distance from one’s job or feelings negative towards one’s career
    • Reduced professional productivity

    Now as healthcare students, we may not be “employed”, but, especially in the clinical years, we undertake a lot more professional responsibility and engage in work patterns such as night shifts, weekend shifts. This is vastly different to our other student counterparts and can be emphasised when you continually decline that Monday night-out due to the 8:30am ward round. 

    Recently, I watched “super high resolution” – a highly emotive play at Soho Theatre. The play centred around Anna, a 31-year-old A&E doctor who’s at breaking point due to stress and lack of sleep. What’s poignant about this play is that ultimately, she is thrown over the edge by stress within her personal life. The underlying idea behind this, is to portray how a medical career gives us little leeway to deal with personal circumstances. Whilst many may be able to have ample time off, our duty of care to the wider public means that often our lives take the backseat. 

    I found this an insightful and nuanced way to approach the issue of Burnout – as the focus is on the consequences of a career in healthcare, rather than simply describing the “broken structure” of NHS that is constantly within media discourse. 

    Upon reflection, it’s clear that these consequences on personal life are not limited to being a Jr. Sacrificing events, conversations and hobbies is something we’re all expected to do. 

    So, what can be done?

    Fortunately, conversations around Burnout are increasingly prevalent, removing the taboo that many previous generations of graduates have undergone. Media pieces such as “super high resolution” and “this is going to hurt” do well to inform both healthcare professionals and the public of the humans behind healthcare. 

    As friends and colleagues, it’s important to recognise the signs of burnout within this community. 

    Once recognised, it’s a good idea to make this known (in a comfortable environment) and take steps to mitigate this worsening. A gym session or a walk with a coffee is not going to cure the feeling of burnout – but it may provide some welcome relief. 

    Re-assess your workload; is there anything that can be moved down the priority list? 

    Ticking off a to-do list may be a satisfying, but it’s important to ensure that the to-do list isn’t longer than the number of lines on the page (which is easily done); just looking at that list is enough to incite worry in most of us. 

    Perhaps the most important point is to make sure that you don’t engage in negative self-talk. Many people talk themselves down when things aren’t going their way, it’s counter-productive and mentally harmful. We’re all doing the best we can and sometimes your best is just keeping afloat. 

    The purpose behind this article wasn’t to provide a sermon on how to defeat burnout. It’s just a reflection, written by a medical student for others to read and to keep the conversation going.

  • Is it Ethical to Withdraw Artificial Nutrition and Hydration from Patients with Persistent Disorders of Consciousness?

    Is it Ethical to Withdraw Artificial Nutrition and Hydration from Patients with Persistent Disorders of Consciousness?

    Holly Dobbing, Year 3

    A persistent disorder of consciousness (PDOC) is a disorder of consciousness that lasts for more than 4 weeks after a sudden brain injury (n.d., 2020). But what is a disorder of consciousness you may ask? Well, that depends on how you define consciousness. And that’s a whole essay in itself. For this article, I will be considering consciousness as being both aware and awake. So, using that, a disorder of consciousness is a disorder that impacts either awareness, wakefulness, or both. This includes comas, vegetative states (VS and minimally conscious states (MCS) (n.d., 2020). A VS is wakefulness with absent awareness, whereas a MCS is wakefulness with minimal awareness. In contrast to both, a coma is absent wakefulness and absent awareness. 

    Diagnoses of PDOCs are made over time and are based on careful clinical evaluation and observation of the patients’ behaviours by trained professionals using validated structured assessment tools (n.d., 2020). Friends and families also play a huge role. It is absolutely critical to be confident in these diagnoses as they have an immense impact on how the patient is treated going forward. 

    Due to the extent of impairment of their cognitive function, patients in PDOCs require artificial nutrition and hydration (AHAN via a percutaneous endoscopic gastrostomy (PEG) tube – a tube directly through the skin into the stomach (Quiñones-Ossa et al., 2021). Through this, doctors can feed the patient, give them water and administer medications because they’re unable to swallow substances orally (Quiñones-Ossa et al., 2021). Because insertion of a PEG tube requires medical intervention, AHAN is therefore considered a treatment, not a human right like normal food and water in hospital (Quiñones-Ossa et al., 2021). This means that in the circumstances of a patient with a PDOC, AHAN can be withdrawn like any other medical treatment. 

    Currently in the UK, as long as two expert doctors and the family are in agreement, AHAN can legally be withdrawn (n.d., 2020). If the family don’t agree with the doctors, or the family don’t agree with each other, the case goes to court, whether or not withdrawal of treatment is in the patient’s best interests is decided by a judge (n.d., 2020). 

    But who should have the right to determine best interests? Often, patients’ families play a huge role in deciding what the patient would have wanted, but sometimes it’s not that simple. In some cases, family members disagree about the best interests of the patient, and also families are unable separate what the patient may have wanted from their need to keep them ‘alive’. It is likely that patients who do emerge from PDOCs will be profoundly disabled (Quiñones-Ossa et al., 2021), and it is important for families to also consider this. In saying this, I also believe that the decision should not solely be down to the families because it is a huge burden and emotional strain to have to decide whether a loved one should be kept alive or not. Therefore, I think doctors play a crucial role in guiding these decisions supporting families during these difficult discussions. 

    Another consideration is that withdrawal of treatment will cause death, so really, isn’t this just euthanasia with a different name? Actually, there is a subtle difference. The NHS defines euthanasia as ‘the active and deliberate ending of a person’s life to relieve suffering’, suggesting a more active act in bringing about death (NHS, 2020). In the UK, euthanasia is illegal in all circumstances (NHS, 2020). In contrast, withdrawal of treatment is simply stopping treatment because it’s no longer beneficial, not with the intention of causing death. It’s a very slight difference, but it’s one that allows doctors to give patients this peace without actively causing their death. 

    As doctors, we also have a responsibility of benevolence, or in other words, to preserve life, restore health and relieve suffering. Similarly, the ethical pillar of non-maleficence links to our responsibility to avoid harm. So how can we possibly justify essentially starving a patient of food and water? Is this not a barbaric way to bring about a patient’s death? In some ways, starving a patient of nutrition and hydration seems like a cruel and slow suffering, although I can understand that it feels less like killing a patient than injecting them with a lethal dose of a drug that will end their life. Research shows that patients in PDOCs are unlikely to experience pain and after withdrawal of treatment, analgesia is still given to keep the patient settled so as carers, we hope this means they don’t suffer (n.d., 2020). Still, without definitive proof, this seems somewhat inhumane, and I can’t help but feel a quicker, painless option could be kinder. 

    And finally, is it fair to prolong life with minimal evidence of recovery? In a world where hospital beds are scarce, shouldn’t we prioritise patients with a higher chance of recovery? I think in some ways this is a really valid argument because patients who are in PDOCs secondary to hypoxic brain injury for more than 3 months or traumatic brain injury for more than 12 months are highly unlikely to recover (n.d., 2020). Still, as an optimistic person, I can completely appreciate that families will need more than ‘highly unlikely to wake up’ before they accept that the treatment is futile.  

    In my opinion withdrawal of AHAN is ethical when repeated assessments have indicated little chance of recovery because we can limit the patient and, possibly more so, the family’s suffering. I also think that, given the lack of definitive knowledge about the patients’ consciousness and experiences whilst in a PDOC, we can’t rule out that this is a state worse than death and, in that case, we must not prolong it if there are no signs of improvement. Furthermore, I think that with the huge strain the NHS is under currently, it is difficult to justify keeping patients alive in PDOCs for years upon years with no hopes of emergence. For these reasons I do support withdrawal of AHAN, although I think that more could be done to support families in making this awful decision.  

    References

    N.D. 2020. Prolonged disorders of consciousness following sudden onset brain injury: national clinical guidelines.

    NHS. 2020. Euthanasia and assisted suicide [Online]. Available: https://www.nhs.uk/conditions/euthanasia-and-assisted-suicide/ [Accessed 30th November 2022].QUIÑONES-OSSA, G. A., DURANGO-ESPINOSA, Y. A., JANJUA, T., MOSCOTE-SALAZAR, L. R. & AGRAWAL, A. 2021. Persistent vegetative state: an overview. Egyptian Journal of Neurosurgery, 36, 9.

  • If You Put Your Mind To It, It Will Happen: a Brief Reflection on The Law of Attraction

    If You Put Your Mind To It, It Will Happen: a Brief Reflection on The Law of Attraction

    Jamie Mistry, Year 3

    Your thoughts have an impact on your life. Your mindset shapes your thoughts, behaviours, and actions. Behaviours tend to influence enters our lives and who stays, as a resource or a liability. Your thoughts and behaviours also shape how you feel about yourself and the world.

    Fuelling your mind with negative thinking doesn’t help your well-being or encourage flourishing, happy relationships. And it certainly doesn’t help you manifest something better.

    On some days, it’s hard to look on the bright side. No one should expect to always feel or be positive, but a positive attitude helps. So does an optimistic mindset. Changing the way, you feel about yourself, and the world can change the way people think about and treat you. That can have real outcomes.

    This is the essence of harnessing “the law of attraction” to change your life.

  • Deutschland 83 Channel 4 Drama Series Review

    Deutschland 83 Channel 4 Drama Series Review

    Jamie Mistry, year 3

    A 24-year-old East German, Martin, who is plucked from a comfortable life in the military and, against his will, turned into a spy, that nation’s secret police. His assignment is daunting: He is to assume another man’s identity and become an aide to a West German general at the heart of NATO’s nuclear-deterrence strategy.

    In the style of a lot of current shows, “Deutschland 83” mixes real historical events into its made-up story. Ronald Reagan and other leaders of the period turn up in video clips spouting their Cold War bombast, verbiage that today feels both scary and ridiculously simplistic.

    The show has the feel of a cold war series, with a young main character who both is buffeted by these grown-up forces and is the only glimmer of hope in a world gone mad. 

    The series also has some fun with Martin’s encounters with the practices, luxuries and technologies of the West. The telephone system baffles him. Hotel soaps and lotions are a revelation. The practice of billing a meal to your room number leads to some embarrassing miscommunication with a waitress.

    In the end, it is a must watch. It combines love, the threat of war and the emerging times that occurred during post war Europe. 

  • Vero Cells – The New Fight Against COVID-19

    Vero Cells – The New Fight Against COVID-19

    Jonathan Boby John (MSc. Clinical Embryology & ART)  

    The emergence of novel coronaviruses that have caused more lethal illnesses (namely SARS, MERS  and COVID-19) has led to an increase into research of coronaviruses and for identifying antiviral  strategies for COVID-19 in particular. Vero cell lines are one of a number of cell lines that are being  used in a large number of these studies. Examples of these studies include evaluation of existing  antiviral and other drugs for improved treatment within as short a time-frame as possible. 

    The Vero cell line is an immortalized cell line established from kidney epithelial cells of the African  green monkey. A variety of Vero sublines have been developed and can be classified into four major  cell lineages. Vero gets its name from a derivation of green kidney – Verda Reno. Verotoxin, a potent  E.coli toxin that is involved in severe food poisoning and can cause kidney failure, was originally so named (now known as shiga-like toxin) as it was first screened by its ability to kill vero cells. Vero cell  lines are used less frequently in biological studies than the more popular HeLa cell line, in part  because this is a non-human cell line. However, vero cell lineages are still widely used for screening  purposes for bacterial toxins, viruses and for parasite studies. Since they are derived from normal  kidney cells and not immortal cells like HeLa, Vero cells retain the attributes of normal cells, notably  cell contact inhibition. So, once they reach confluence in the cell mono layer, they need to be  passaged otherwise they will start to die off. In addition, Vero cells have been used in the  development and validation of techniques such as super resolution microscopy. Other applications  include detection of verotoxins, detection of virus in ground beef, efficacy testing, study of malaria,  media testing, vaccine development, protein expression, and mycoplasma testing.

    Vero cell line was initiated from the kidney of a normal adult African green monkey on March 27,  1962, by Y. Yasumura and Y. Kawakita at the Chiba University in Chiba, Japan. Vero cells are one of  the most common mammalian continuous cell lines used in research. This anchorage-dependent cell  line has been used extensively in virology studies, but has also been used in many other applications,  including the propagation and study of intracellular bacteria (e.g., Rickettsia and parasites; Neospora), and assessment of the effects of chemicals, toxins and other substances on mammalian  cells at the molecular level. In addition, Vero cells have been licensed in the United States for  production of both live (rotavirus, smallpox) and inactivated (poliovirus) viral vaccines, and  throughout the world Vero cells have been used for the production of a number of other viruses,  including rabies virus, reovirus and Japanese encephalitis virus. The protocols outlined in this  appendix detail procedures for the routine growth and maintenance of Vero cells in a research  laboratory setting. There are several lines of Vero cells commercially available (i.e., Vero, Vero 76,  Vero E6), but they were all ultimately derived from the same source, and the protocols in this unit  can be used with any line of Vero cells. 

    It is often difficult to obtain robust data from the clinical cases directly given the many variables  involved. For example, use of anti-viral treatments may have improved patient outcome if given at  an early stage but not once complications developed further, or that the patient may have recovered  regardless of being given a specific treatment. Therefore, effective research models are one 

    important part of helping to determine what anti-viral treatments can be seen to have a statistically  relevant impact and warrant further study. 

    Screening for the toxin of first named “Vero toxin” after this cell line, and later called “Shiga-like  toxin” due to its similarity to Shiga toxin isolated from Shigella dysenteriae. The cell bank is easy to  establish and preserved and at the same time it can be continuously processed with a fast growth rate.  Vero cells have stable genetic traits and a low probability of malignancy. Vero cells are sensitive to a  variety of viruses and have high virus titers.  

    Vero cells stem from monkeys and are therefore a non-human cell line. This will in most cases affect  conclusions drawn from experiments in Vero cells, especially if they are being extrapolated to  humans. The production of biopharmaceuticals in Vero cells will always carry the risk of producing  undesired products. Post-translational modifications such as glycosylation can vary dramatically  between species and affect product properties and quality. The origin of a cell line from epithelial  kidney cells should always be kept in mind, as this will affect cellular properties and outcomes.  Possibility of continuously culturing a cell line also harbours potential risks, as cell lines change and  adapt during long-term culture, altering their characteristics. 

    More current applications rely on the lack of interferon-production of Vero cells, which makes them  susceptible to infection by many viruses, making them prime candidates for the production of  viruses and testing the effect of antiviral drugs on viral replication. Analogously, Vero cells are  frequently used for producing vaccines which often rely on viral particles or proteins. In addition to  testing therapeutics, Vero cells can also be used to quantify virus concentrations as infectious doses  via plaque assay. Here, culture dishes confluent with Vero cells are treated with increasingly diluted  virus-containing solutions that will lyse cells and create plaques that can be counted.