NMSJ Nottingham Medical Students’ Journal
The Future of Medicine
Cover image by Charlotte West
Within this issue: The Future of Medicine • • • • • •
Climate Change and the Emergencies of Zoonotic Infectious Disease Case Report: Earth in a Bad State Curriculum Development The Development of a Malaria Vaccine and Means for Modern Medicine Is Google Damaging the Relationship Between Doctors and Patients Exploring Human Longevity: The Impact of Climate on Life Expectancy
Societies • • • •
UoN Co-Responders: Going Green Teddy Bear Hospital Paediatric Conference 2020 Palliative Care Society: A Look to the Future Street Doctors
Stories and Views •
Final Year, Final Hurdle
Creatives • • • • •
An Ode to What Once Was He Remembered Turn Before the Brink Anatomical Artwork by Jasmine Plummer The 2 Hemispheres
With contributions from: Ameera Haseen Aymen Dar Caitlin Hopkins Elizabeth Gay Feba Varghese Insiya S.H.Saifudeen Jasmine Plummer Lily Marrable Prashamsa Manchiraju Simran Dhugga Zenab Ahmed
Anjali Mehta Brooke Gerrie Catherine Furlong Emma Midgley Gill Pinner Isobel Lewis Lucy Ward Natasha Harris Riya Kewalani William Richards
Welcome from the editors Catherine Furlong, Nic Miller and Issy Walker As a regularly enthusiastic writer for the journal over the past year and a half, I never would have thought I'd wind up becoming the editor and yet, here we are! As this is my first edition that I've put together with the help of the rest of the team, please be kind and understanding as this quite literally is my baby that I've been nurturing for a long 3 months now. This edition, I wanted to desperately try to take a break from COVID (something I think we could all use!) and instead focus on something equally as important, that being the future of medicine and climate change. We're all going to be around to see an enormous amount of change in the medical field and more than likely, climate change is going to be one of the main drivers of this change.
We hope you enjoy this latest edition of the journal just in time for the holidays and as always, do let us know if you have any ideas to help us better the journal, we're always looking for a new angle.
December 2021 4
Year Rep Team
Year 1 Rep – Aymen Dar
Year 2 Rep – Prashmsa Manchiraju
Derby Rep – Charlotte West
Year 3 Rep Ignancy Kozlowski
Editors Team
Features – India Capper
Advice & Wellbeing – Ahsab Chowdhury
Stories & Views – Natasha Harris
Societies – Anna Kober
We are now looking for a Creatives Rep – get in touch if you want to get involved!
Social Media Manager
Prashmsa Manchiraju
The Future of Medicine Case Report: Earth in a Bad State Climate Change and the Emergence of Zoonotic Infectious Disease Curriculum Development The Development of a Malaria Vaccine and Means for Modern Medicine Is Google Damaging the Relationship Between Doctors and Patients Exploring Human Longevity: The Impact of Climate on Life Expectancy
Case Report: Earth in a Bad State Zenab Ahmed
The art of medicine consists in amusing the patient whilst nature curses the disease. – Voltaire
Description Name: Planet Earth Age: 4.543 Billion years old Date of admission: 10/11/2021
Description The Earth has presented with chronic symptoms of hyperthermia, dehydration and stomach pains. X-ray shows multiple foreign object such plastic , cigarettes and straws lodged inside the patient. In addition, the natural biosystem is disturbed due to an increased number of poisoned animals that subsequently increased the acidity of the sea . The patient seems to be in distress and reports changes in moods, oscillating between flooding and thundering. Oxygen saturations are low and suffering from hypoxia with abnormal levels of CO2 . Treatment: advised the patient to reduce plastic consumption, use more sustainable energy sources and increase their nutrient intake.
Prognosis If causes are not treated with urgency , QALY would be reduced by ~ 1.4 years. If continued, endangered species may cease to exist, and dramatic weather events will continue to happen such as thunderstorms and wildfires that the earth is now experiencing.
Climate Change and the Emergence of Zoonotic Infectious Disease Feba Varghese
While there are some natural phenomena associated with climate change, such as volcanic eruptions, earth’s orbital eccentricity, and ocean currents, the main causes of climate change are anthropogenic. Deforestation, mining, intensive agriculture farming, unplanned urbanisation and intensive use of fossil fuel contribute to adverse changes in ecosystems. Among those are loss of biodiversity, fragmentation and destruction of habitats, as well as spillover events; these factors are additionally connected to the emergence, and re-emergence, of zoonotic infectious diseases.
The Fine Balance of Our Ecosystems Ecosystems are integral in controlling the dynamics of many zoonotic diseases, and as such changes to the ecosystem risk upsetting the balance, resulting in the emergence and re-emergence of various infectious human diseases. Hypothetically, loss of biodiversity should have an equal probability of increasing or decreasing the prevalence of disease- however, more often than not, loss of biodiversity heightens the transmission of pathogens, and thus infectious disease. Deforestation is one of the main drivers of climate change and may directly result in the loss of biodiversity through elimination of natural habitats belonging to a wide range of species. This may give rise to infectious diseases in two ways; Firstly, if the species lost is not a host, or is a suboptimal host, for the pathogen, loss of animal diversity may predispose a particular infectious disease. For example, studies carried out in the USA and Panama have reported an increase in Hantavirus (a rodent-borne disease transmitted through virus-containing particles in urine and droppings) in areas where there is a low diversity of small mammals that are also susceptible to the virus. However, they dilute cases of infection in the rodent population, thus reducing the risk of transmission. Reducing the abundance of incompetent hosts may also increase the risk of transmission from rodents to humans, as more rodents are likely to carry Hantavirus. Secondly, loss of biodiversity may limit food and shelter availability as well as breeding habitats for wildlife, resulting in loss of predators and competition for pathogen reservoirs. Consequently, this increases rates of disease transmission, provided that the lost species is not capable of hosting the pathogen.
The Impact of Human Activity on Nature Studies have shown that vector diseases, such as malaria and dengue, are driven by climate change and deforestation. Pathogens rely on vectors and a favourable environment for reproduction, proliferation and therefore transmission. Habitat fragmentation forces mosquitoes to relocate to the edge of the amazon rainforest, thus limiting access to natural resources. This augments the risk of exposure to malaria for humans entering the habitat. However, an even greater impact of deforestation and climate change on the emergence and re-emergence of malaria can be attributed to an associated temperature change. Variations in climate can influence the survival of pathogens and their ability to act as vectors of disease. For example, atmospheric temperature and relative humidity determine the abundance and activity of mosquitos. Increasing temperatures reduce the extrinsic incubation period (EIP), which is the time taken for a pathogen to become infectious within its host. In Plasmodium falciparum (P.falciparum), the most common and deadliest of the parasites that cause malaria, the EIP drops from 26 days at 20°C to 13 days at 25°C. The shortened EIP increases a host’s infectivity, thus expanding the number of infectious vectors.
Disease Transmission: From Animals to Humans Increasing anthropogenic activities in forests, such as deforestation, agricultural expansion and mining, increase contact between human and wildlife, precipitating pathogen spill-over. This occurs when a population with an abundance of a particular pathogen encounters a new population. In some cases, the resulting disease may spread to humans, with or without further human contact. Nipah virus is an example of a spill-over event; It was transmitted from wild fruit bats to domesticated pigs, and subsequently to humans. Transmission to pigs was achieved through repeated spillover events from bats to pigs, which, in turn, increased the incidence of spill-over events transmitting the disease to humans. Successful spill-over events require close physical and phylogenetic proximity between the affected species. Studies have shown that at least 50% of emerging infectious diseases, including Zika, Severe Acute Respiratory Syndrome (SARS) and Ebola, to be zoonotic. Thus, close surveillance of zoonotic disease and vector control is critical for global health by reducing population vulnerability. This may be facilitated by newer zoonotic risk technology that generates more accurate data. That said, its benefits rely on a strong interdisciplinary scientific community to be proactive in forming decisions based on findings, as well as better healthcare infrastructure and public awareness of emerging infectious diseases.
Curriculum Development
Brooke Gerrie (BG), Caitlin Hopkins (CH), Gill Pinner (Supervisor) Background and Aim Climate change is the biggest public health threat of our lifetimes (1). With impacts ranging from food and water insecurity, changing vector ecology and mental health burden, medical students are unprepared for the public health crisis they will face in their careers. The Planetary Health Report Card (PHRC) initiative (4) conducts yearly reports, assessing medical schools’ engagement in sustainable healthcare education. Our aim is to address our curricula and identify where further teaching can be integrated, helping us to meet GMC requirements and match University sustainability targets.
Method Nottingham medical student (CH) carried out the 2020/21 PHRC (5). Results and recommendations were presented to the Medical Education Unit, alongside the international PHRC published results. Medical student (BG) assessed literature and case studies of initiatives at other medical schools (2), identifying which would be most easily integrated into the curriculum and most engaging. Discussions with curriculum leads highlighted that teaching must be accessible, relevant to level of study and meet GMC requirements.
Results and Discussion A Climate and Health Steering Group has been approved to oversee curriculum changes, address PHRC recommendations and implement in-house sustainability efforts (3). This group will be staff and student-led, composed of student representatives and curriculum leads from pre-clinical and clinical phase cohorts. The group will be embedded in the current course governance structure and address all streams: foundation, undergraduate, GEM and Lincoln. The university-wide sustainability team wish to work with the group to engage healthcare students of all faculties. The PHRC summarises the school’s engagement, stating the grade achieved and individualised recommendations within five key areas. Recommendations, if successfully implemented, would improve the medical school’s grade. As the medical school is assessed annually, progress will be reviewed on a yearly basis and further developments and recommendations can be evaluated by the Steering Group.
To introduce students of all levels to sustainable healthcare, an online resource was created for students on the virtual learning platform, covering ‘impacts on health’, ‘impact of the healthcare system’ and ‘how healthcare professionals can help’. Specific components for final year students include online resources, a CPD certificate and debates on sustainability. Nottingham, alongside several other UK medical schools has signed a Climate and Health Emergency public declaration.
Conclusion To date, student initiatives have driven change but, following the establishment of a steering group, interested faculty will work with students to ensure further curriculum development and delivery, to address the importance of global health and sustainability issues.
The Development of a Malaria Vaccine and What This Means for Modern Medicine Isobel Lewis
In what has been described by WHO director general Tedros Adhanom as a ‘historic moment’, the world’s first ever malaria vaccine has been developed. The RTS,S (brand name Mosquirix) vaccine, was initially synthesized in 1987 and began pilot implementation in 2019 following approval by the WHO on the 6th of October. This ground-breaking vaccine has the potential to save tens of thousands of young lives suffering with this deadly disease.
What is Malaria? Malaria is an ancient, parasitic disease and has been plaguing humanity for millennia, having been found in preserved mosquitoes from approximately 30 million years ago. It is bloodborne and is spread by the female Anopheles mosquito. The disease produces symptoms including fever and malaise and can often be fatal. Malaria is a tropical and subtropical disease and is endemic in areas such as Sub-Saharan Africa and Latin America. Children are more commonly affected by the disease as, unlike adults in endemic areas, they have not built-up immunity against the disease. Tragically, it is estimated that around 260,000 children under 5 in Africa die from the disease annually.
What Vaccine Developments Have Been Made in the Past? Research towards a malaria vaccine began in 1967 with seminal studies in mice. Since then, there have been multiple attempts to develop a candidate but until recently, no successful vaccine had been found. So why is this and what makes the Mosquirix vaccine different? The lack of funding and interest in developing a malaria vaccine may be partly responsible for its slow progress. Malaria is a disease endemic to poor countries and as such there is little financial incentive for vaccine development. Despite this, the RTS,S candidate was helped along by Bill and Melinda Gates who donated $700,000 to enable its progression to clinical trials, which may have contributed to the success of this particular candidate.
Furthermore, there are long encountered difficulties when it comes to designing a vaccine for a parasite which inhibits both human and mosquito hosts. The RTS,S vaccine itself is a subunit vaccine. It contains a small part of the malaria parasite which is produced as a protein and causes the body to make antibodies against the malaria parasite.
Mosquirix: A Promising New Vaccine The phase two trial for the RTS,S vaccine was published in the Lancet. The trial was a double-blind randomised control trial which aimed to assess the efficacy of three RTS,S vaccine doses at 4-week intervals. The vaccines were given before the malaria season to eligible 5 to 17 month olds in Nanoro, Burkina Faso, and one further dose given a year later. The cohort of 450 was split into groups of three, with 150 participants in each. The first two groups received different doses of the RTS,S vaccine while the control group received a rabies vaccination. At the 6-month period vaccine efficacy was found to be 74% in group 1 and 77% in group 2, with efficacy remaining high after 1 year. There were only mild adverse events, most prominently a fever. Its effectiveness against malaria takes it above the required WHO target of 75%.
A phase 3 trial of the vaccine is currently underway, looking at its efficacy across five African sites with varying malaria transmission and seasonality. It remains to be seen whether the Mosquirix vaccine will become part of the national malaria control strategy for affected countries. There are also concerns regarding the ability of malaria-endemic countries to mass produce such vaccines. These concerns echo those seen surrounding the production of the covid vaccination in the developing world. There are yet more similarities between the two vaccines; The Norovax covid vaccine candidate, still in trials, uses the same protein subunit technology as that of the malaria vaccine. Furthermore, it is hoped that the rapid advancements in covid vaccine technology in coming years will assist in the development of more sophisticated and effective malaria vaccines, as well as bolstering the capacity for vaccine mass production.
Conclusion The rapid and recent development of the covid and malaria vaccine herald a new age for vaccine technology. This is increasingly important in the pandemic-plagued, gradually warming age that we live in. As climate change progresses, it is expected that increases in temperature and humidity will extend breeding grounds for malariacarrying mosquitos into novel areas, as well as increasing its proliferation in existing endemic areas. This is one of the many likely health consequences of climate change. Despite the effort of politicians at COP26, it may ultimately be the scientists that save us.
Is Google Damaging the Relationship Between Doctors and Patients Ameera Haseen
In the modern internet age, where everything is easily accessible and found at the click of a Google search, you find many people becoming their own doctors and selfdiagnosing. We all know of someone, even yourself, who avidly searches their symptoms and suddenly, a headache becomes a brain tumour. There are countless sources out there, the number of health-related websites souring to over 50,000 organisations and providing health and social-care advice and all from the comfort of your own home. With the internet quickly becoming the 3rd part of the doctorpatient relationship, we as future doctors must be able to adapt as patients become better informed about their ailments. So how does entering this new age of technology change the dynamic between the patient and doctor; is it a hindrance or a help?
Does Google do More Harm than Good? In the current climate, many people conscious about any health-related symptoms can simply hit the search bar and find themselves a diagnosis. But this could become a problem. Self-diagnosing through search engines may lead to excessive worrying or anxiety before you even step foot inside a GP practice. You may end up overestimating symptoms, taking unnecessary OTC medications, or requesting wrong and useless treatment. On the other side of the coin, you could underestimate a potentially serious condition and not seek the medical help you need. The result of all of this? A developing epidemic of health anxiety, more commonly known as becoming a hypochondriac. Living in fear of a serious and undiagnosed medical condition used to be confined to a simple conversation, but now comes with a series of online forums and poorly sourced articles. As this neoteric malady races the globe, a new term has been created, ‘cyberchondria.’ A study involving 515 participants and their search experiences and found that 20% percent of respondents experienced an escalation of concerns. Behavioural problems occurred in 40% of participants including more frequent consultations, more page visits and increased internet searches.
Credible Sources For most of us, we do not spend hours scouring the internet and instead, stick to the first page of the Google search, rendering the sources of medical information small and potentially completely inaccurate. One study found that out of 23 websites containing information concerning diagnosis and treatment, the correct diagnoses only came up a mere 34% of the time. Patients are unlikely to check if they are reading credible sources and take what they see at face value, allowing false medical information to spread. The ranking factor of Google often prioritise articles that are well-optimised over reliable sources, adding to the problem. The lack of plausible material on hand for patients poses a major problem for clinicians and is one of the leading worries of future healthcare.
Benefits and Risks Doctors agree that it can be difficult treating patients who have already selfmedicated following an impromptu internet search. Not only is the pharmacological side of this concerning, but it also poses a challenge when trying to discuss medical conditions and treatment if they have a predisposed opinion. With the ever-growing sea of online forums available, hosting hundreds of medical discussions every week, this only feeds into the problem. It makes for the perfect breeding ground for false information to spread, creating the ideal environment for scaremongering. But of course, we cannot only look at this from a pessimistic and gloomy point of view. Patients having the freedom to interact with one another over the internet can provide varying experiences and reassurance from those with the same conditions, allowing them to see that they are not alone and can seek advice from others. It provides a sense of community amongst fellow patients, allowing them to share advice and their individual struggles. This new and emerging cyberspace is further beneficial by allowing information about health conditions discoverable in the switch of a button and there are certain wellknown and reputable sites accessible to patients, including our old and trustworthy NHS. Learning about your own diseases, especially a chronic illness, can give patients power over their own healthcare and level the playing field in clinical interactions. It could have a brilliant potential for good in public health, educating the general public on several preventable diseases such as COPD and type 2 diabetes. A survey was done which found 89 individuals (58%) who had used the internet to look for information on medical issues or health-related concerns. Among these respondents, 55% stated that the information they found changed the way they thought about their health. Furthermore, it can create interest in their own health and wellbeing therefore making positive and healthy lifestyle changes which can benefit wider society.
GP Consultations The patient-doctor relationship has evolved over time, moving away from the doctor taking on a figure of authority to a more collaborative approach where patients are more in control of their health. In an average GP appointment, 10 minutes are given to the patient to explain, listen and gain a diagnosis. If the patient has already researched their suspected condition prior to the appointment, they may have conflicting views to the doctor after reading medical articles online. This could lead to a flurry of unnecessary questions stemming from information online, putting a further strain on the doctor to stick to the 10 minutes. This in itself, can cause its own problems and can make the patient feel as though the doctor is rushing, giving the impression of a lack of interest or care. Patients can be more forward and assertive in self-diagnosing, adamant for unneeded tests or treatment. If denied, they could lose trust in the doctor and the healthcare system and even fail to seek help for future illness which could have catastrophic effects. This shift in the doctor-patient dynamic is only going to grow as data becomes more attainable with the amount of people owning a phone worldwide already at 80.63% and rising. Looking at the doctors’ perspective, if they disagree with the patient views, this can create a distrust and the patient may not think they have their best interests at heart.
There is a positive side to this though. By having patients more involved in the consultation. And asking questions, it gives the doctor time to clarify information and ensure that the patient fully understand what is being said. This is also proven to alleviate any anxieties, building that trust that is so important in healthcare. This more active role that the patient takes on allows them to have greater autonomy in their own health and creates a potential new collaborative and open relationship between patients and doctors. By changing the power dynamic of this old and outdated relationship norm, patients may feel more inclined to listen to healthcare professionals if they feel they are being heard too, making for better patient-centred care.
Conclusion So, what can be learnt here? The future of healthcare is going to bring with it an increasing number of well-informed patients coming to professionals with a pool of medical information. The relationship of doctors and patients as we know it is bound to evolve and is continuously changing, giving the patient more power over their own health. As future medical professionals, it is integral that we integrate ourselves into that change and avoid a power struggle. We need to strike a balance with management of information brought forward and maintaining a trusting relationship for the best healthcare possible.
Exploring Human Longevity: The Impact of Climate on Life Expectancy Riya Kewalani, Insiya Sajjad Hussan Saifudeen Abstract This research aims to investigate whether climate has an impact on life expectancy. In analysing economic data from 172 countries that are publicly available from the United Nations World Economic Situation and Prospects 2019, as well as classifying all countries from different regions into hot or cold climate categories, the authors were able to single out income, education, sanitation, healthcare, ethnicity, and diet as constant factors to objectively quantify life expectancy. By measuring life expectancies as indicated by the climate, a comprehensible correlation can be built of whether the climate plays a vital role in prolonging human life expectancy and which type of climate would best support human life. Information gathered and analysed from examination focused on the contention that human life expectancy can be increased living in colder regions. According to the research, an individual is likely to live an extra 2.2163 years in colder regions solely based on the country’s income status and climate, while completely ruling out genetics. KEYWORDS: Earth and Environmental Sciences; Life expectancy; Climate Science; Longevity; Income groups.
Introduction To better understand the study, it is crucial to understand the difference between life span, life expectancy, and longevity. According to the United Nations Population Division, life expectancy at birth is defined as “the average number of years that a newborn could expect to live if he or she were to pass through life subject to the age-specific mortality rates of a given period.” ¹ When addressing the life expectancy of a country, it refers to the mean life span of the populace in that country. This factual normal is determined dependent on a populace in general, including the individuals who die during labor, soon after labor, during puberty or adulthood, the individuals who die in war, and the individuals who live well into mature age. On the other hand, according to News Medical Life Sciences, life span refers to “the maximum number of years that a person can expect to live based on the greatest number of years anyone from the same data set has lived.” ²
Taking humans as the model, the oldest recorded age attained by any living individual is 122 years, thereby implicating that human beings have a lifespan of at least 122 years. Life span is also known as longevity. As life expectancy has been extended, factors that affect it have been substantially debated. Consensus on factors that influence life expectancy include gender, ethnicity, pollution, climate change, literacy rate, healthcare access, and income level. Other changeable lifestyle factors also have an impact on life expectancy, including but not limited to, exercise, alcohol, smoking and diet. Nevertheless, life expectancy has for the most part continuously increased over time. The authors’ study aims to quantify and study the factors that affect human life expectancy. According to the American Journal of Physical Anthropology, Neolithic and Bronze Age data collected suggests life expectancy was an average of 36 years for both men and women. ³ Hunter-gatherers had a higher life expectancy than farmers as agriculture was not common yet and people would resort to hunting and foraging food for survival. From then, life expectancy has been shown to be an upward trend, with most studies suggesting that by the late medieval English era, life expectancy of an aristocrat could be as much as 64 years; a figure that closely resembles the life expectancy of many populations around the world today. The increase in life expectancy is attributed to the advancements made in sanitation, education, and lodging during the nineteenth and mid-twentieth centuries, causing a consistent decrease in early and midlife mortality. Additionally, great progress made in numerous regions of well-being and health, such as the discovery of antibiotics, the green revolution that increased agricultural production, the enhancement of maternal and child survival, and mortality from infectious diseases, particularly human immunodeficiency virus (HIV)/ AIDS, tuberculosis (TB), malaria, and neglected tropical diseases (NTDs), has declined. According to the World Health Organization (WHO), global average life expectancy has increased by 5.5 years between 2000 and 2016, which has been notably the fastest increase since the 1950s.⁴ As per the United Nations World Population Prospects, life expectancy will continue to display an upward trend in all regions of the world. However, the average life expectancy isn’t predicted to grow exponentially as it has these past few decades. Projected increases in life expectancy in Northern America, Europe and Latin American and the Caribbean are expected to become more gradual and stagnant, while projections for Africa continue at a much higher rate compared to the rest of the world. Asia is expected to match the global average by the year 2050. Differences in life expectancy across regions of the world are estimated to persist even into the future due to the differences in group incomes, however, income disparity between regions is forecasted to diminish significantly by 2050 (Figure 1).⁵
Figure 1: Trend line of life expectancy from 1950 to 2050 by world regions. Source: Life Expectancy by Region from UN World Population Prospects. The graph illustrates exact increases in life expectancy until 2017, and then predicts trends to 2050.
The blue zone areas (Figure 2) are five regions across the world, identified as ‘the hot spots of longevity’ according to National Geographic, where people live much longer than average.6 All of these cities house a population where many individuals hit the 100 years milestone.
When the authors encountered “blue zone” areas in multiple studies about factors affecting human longevity, the authors observed a pattern in the placement of these blue zone areas on the world map-they are all located from 1100 to 4500 km north of the equator, and all experience Mediterranean or tropical climates, or what the authors classified as ‘warm’ in accordance with the designed classification system. The factors attributed to the longer life spans of these communities are healthy diet, daily exercise, and adopting a low-stress lifestyle. However, in no study has climate ever been mentioned as a contributing factor to extending life span in these blue zone areas, when they so clearly have warm and coastal climates as a common factor. This got the authors thinking: does climate play a role in or affect human life expectancy? Scientists have debated the role of climate and temperature in human longevity for decades. On first glance, and while considering blue zone areas, it could be suggested that humans live longer on average in warmer climates. This side of the argument is supported by multiple studies, such as one by Professor F. Ellis of Yale University, who found that deaths in the United States increased by 13% in the winter, compared to the summer, using data from the 1950s.⁷ The opposite side of the debate claims that living in colder climates slows down ageing and thus extends life expectancy. The principal theory corroborating this side of the debate is the ‘free radical theory’ that states organisms age because of buildup in cells and damage from metabolic activities, in particular, a byproduct under the name reactive oxidative species (ROS). The theory claims that exposure to colder temperatures slows down the rate of ageing-thus slowing the release of the byproduct ROS so that less cellular damage occurs over time and thereby slowing ageing and increasing life expectancy.⁸
The authors’ aim with this study was to investigate how rising and warmer temperatures will affect human life expectancy and longevity, which is where climate change comes into play. According to the International Actuarial Association, climate change has already demonstrated that it will have critical and extensive impacts around the globe.¹⁰ The most significant objective for this paper was the mortality of the populace. Climate change is enduring danger to our planet. Largely, this will result from critical rises in CO₂ and methane levels in the Earth's atmosphere, environment, and oceans that have been amassing through many decades. This risk will unfavorably influence our water, air, climate, and ecosystems, bringing about numerous changes to our environment, including augmentations in temperature, changes in precipitation, for example, heavy rains and longer-enduring droughts, a rise of infrequent extreme weather, as well as sea and ocean levels. A definitive impact of these climatic changes will influence human wellbeing, life, and property. Be that as it may, the degree of climate change remains a present-day and grave future dilemma.
Acknowledging the arguments from both sides of the de-bate, and having read, analysed and reviewed the literature available on this topic, the authors set out to quantify any impacts climate has on longevity. By quantifying life expectancy according to climate, a clear correlation can be established of whether climate plays an integral role in human longevity and which type of climate best supports human life.
Figure 2: Cities that form the ‘blue zone’ areas on the world map.9.
Methods The countries of the world were classified initially based on four income groups: high income, upper-middle-income, lower-middle-income, and low income. These classifications were taken directly from the United Nations World Economic Situation and Prospects 2019 Country Classification.¹² Following this, the authors further classified the countries in each income group as ‘mainly warm’ and ‘mainly cold’ (Figure 3). This closed question approach was critical to establish a correlational link between climates, temperature, and human life expectancy. Countries with mainly tropical, subtropical, sub-Saharan, Mediterranean, savanna, and equatorial climates were classified under warm. These countries have dry, arid, hot, and humid temperatures with rainy winters and saw almost no winters with freezing temperatures. Countries with more seasonal climates, temperate, continental, oceanic, maritime, and highland climates were grouped under cold.
Classifying countries based on income groups was essential to keep climate a constant factor as far as possible because income directly affects access to education, sanitation, access to healthcare and diet- all of which also greatly affect human life expectancy. For countries such as the United States, China, and France that experience different climates in different regions or states, the authors collected data about individual state/provincial climates and designated the titles ‘mainly warm’ or ‘mainly cold’ according to the mode or majority. For example, the United States comprises 50 states, out of which 29 experience marine, cold, or very cold climates and 21 experience mixed-dry and hot-humid climates. As a result of this majority, the authors classified the United States as ‘mainly cold”. Figure 3 was drawn up using the Microsoft Excel software based on the number of regions around the world that were classified as warm and cold. Thereafter, mean life expectancies, standard deviation, minimum, and maximum values for each country were calculated based on the data made available from the United Nations World Mortality Report 2019.¹¹ Tables 1 and 2 provide summaries for this data while Figure 6 paints a graphical representation.
Figure 3: World map classified as warm and cold according to the authors’ designed system. Key: warm is represented by yellow, cold by green and data not available as pink.
To create Figure 5, the authors divided the world into twentytwo regions, irrespective of income groups. This was done to single out genetic factors and ethnicity, which too influence life expectancy. The twentytwo regions were then divided into warm and cold regions. The authors classified fifteen as warm and seven as cold. Their mean ages were then drawn up, once again using the United Nations World Mortality Report 2019.
¹¹
To calculate values for ANOVA, the authors used spreadsheet software Microsoft Excel to calculate the (X-mean)² value of each observation. The observations were mean life expectancies of each country listed on the United Nations World Mortality Report 2019.¹¹ These observations were then divided into eight groups: warm socio-economic groups and cold socio-economic groups in accordance with the system described above. The sum of (X-mean)² was calculated for each group. Using this data, variance within each group, total sum of variance, variance within each group, degrees of freedom, F-value, and p-value were also calculated correspondingly using the formulas shown in Figure 4. The calculation was that standard to a typical ANOVA test.
Results and Discussion With global warming and a continuous increase in green-house gases over the decades, climate change has become a peril to mankind. Taking this as a motivation, the research report aims to find a clear link to rise in temperature and its direct effects on human life expectancy and longevity.
Figure 4: Formulas used while calculating ANOVA.
The question of whether climate plays a quantifiable role in human longevity and life expectancy was tested by first classifying all countries according to income groups. Within these income groups, the countries were then further classified as ‘mainly cold’ and ‘mainly warm’ in order to mathematically measure the effects of climate and temperature. The means of ages and life expectancy were then calculated for each income group and cold and warm climates within those groups. The pie chart is a representation of all the different regions around the world classified as ‘mainly cold’ or ‘mainly warm’. The intent was to show the temperature distribution around the globe - with 33.8% being mainly cold regions and 66.2% being mainly warm regions (Figure 5). Across all income groups, the mean life expectancy was higher in the colder climates. With the lowest difference being between the lower-middle income groups, where colder climates displayed an average life expectancy that was 0.2371658 years higher than their warmer climate counterparts. Figure 5: World region climates classified as percentages.
The greatest difference was observed between the low-income groups where the average life expectancy differed by a large 5.9098901 years in the colder climates compared to warmer ones. On average, the minimum life expectancy was higher in all income groups for the colder climate classification, except for the lower-middleincome group where they were almost equal. Additionally, the standard deviation for all income groups in the warmer climates was more spread out than the colder climates, suggesting that the warmer climate regions across all income groups saw a greater disparity in the ranges of life expectancy (Table 1, Table 2, Figure 6).ANOVA, or analysis of variance, is a testing method to prove the statistical significance of the data collected.
The main idea behind ANOVA is to determine how much of the variance comes between groups and how much comes from within groups. According to the calculated ANOVA test, the variance between each group (refer to Table 1 for grouped data) was more than double the variation within each group, which gives the authors a suggestion that climate does have a significant effect on life expectancy. To further test this, the authors calculated the F-value and p-value. The F-value of 49.88126711 is much larger than 1.0, while the p-value comes to exactly 0.00 and is less than 0.05. The p-value denotes that the probability of the null hypothesis taking place is 0% and the large F-value means that variation within each group is more than what could be expected of chance. Together these values indicate strong evidence against the null hypothesis (climate doesn’t affect human life expectancy) and accepts the alternative hypothesis (climate does play a role in human life expectancy), while proving the results statistically significant (Table 3).
Table 1: Summarized statistics of data for warm climate longevity. Data Sources for life expectancy: United Nations World Mortality Report 2019.¹¹
Table 2: Summarized statistics of data for cold climate longevity. Data Sources for life expectancy: United Nations World Mortality Report 2019.¹¹
Table 3: Data calculated for ANOVA.
Figure 6: Tables 1 and 2 data represented graphically to show mean ages and data variation according to various income groups. Data Sources for income classification: United Nations World Economic Situation and Prospects 2019 Country Classification.¹²
The bar chart represents the mean life expectancy across 22regions around the world that are further classified as ‘mainly warm’ (red) which comprises of 15 regions, and ‘mainly cold’ (blue) which accounts for the remaining 7.
Upon examination, the highest life expectancy was found in Southern Europe (82.3 years), Western Europe (81.9 years) and Northern Europe (81.2 years). Within these three regions topping the list of life expectancy, two are classified as mainly cold. On the other hand, three mainly warm regions: Western Africa (57.9), Middle Africa (59.9) and Southern Africa (63.8) have the lowest life expectancies in the world (Figure 5).
Figure 7: Mean life expectancies in different regions of the world. Blue
Data collected and examined from the research points towards the argument that human life expectancy can be extended by living in colder climates. Colder climates overwhelmingly display higher life expectancy in all four of the socio-economic country classifications.
bars illustrate colder regions, while red bars denote warm regions.
All the data collected, recorded, and calculated showed average life expectancy to be higher in colder climates. Whether that difference was just 0.2371658 years higher in the case of lower-middle-income countries, or 5.9098901 years higher in the case of low income; the results indicate that living in colder climates can extend longevity. What can be concluded from this data is that climate change will have definite and lasting impacts on human life expectancy and lifespan. Rising and warmer temperatures will bring a lot of other complications to the table, including but not limited to famines, that could be triggered by these increasing temperatures - effects that no one knows or haven’t yet been predicted. According to the National Geographic, “Since 1906, the global average surface temperature has increased by more than 1.6 degrees Fahrenheit (0.9 degrees Celsius)”. Scientists around the globe have already documented many drastic changes in the environment due to climate changes. Glaciers have contracted, ice on waterways and lakes is collapsing earlier, there have been peak rises in sea levels, intense and longer heat waves, plant and animal ranges have moved with many migrations noticed, and trees are blossoming sooner.¹³ Moreover, the World Health Organization (WHO) states that air pollution contributed by the emissions of fossil fuels as a result of the greenhouse effect, particularly sulfur and nitrogen-oxides can lead to respiratory diseases like asthma which can be seen in adults and children. It is stated that an estimated 7 million people die worldwide annually from air pollution.¹⁴ It is essential to stop climate change as it not only dramat-ically causes natural habitats to become isolated remnants, raises in sea levels, and increases extreme weather, but it also has a negative impact on human life and prosperity. For instance, the WHO has stated, “natural hazards like heat waves can burden health and emergency services and also increase strain on water, energy and transportation resulting in power shortages or even blackouts.
. Food and livelihood security may also be strained if people lose their crops or livestock due to extreme heat”.¹⁵ Agriculture is one of the areas most affected, where farmers are bound to face attacks from weeds and pests which influence yield. Additionally, certain extreme events undermine crop yields. A study at the Bryan College of Health Science shows that the same CO₂ amassing in our environment due to fossil fuels is altering the composition of legumes and fruits that we eat, making them less nutritious.¹⁶ Further increased CO₂ is accelerating photosynthesis and making plants develop with more sugar and less calcium, protein, zinc, and other vital nutrients. Moreover, according to Harvard analysts, on the off chance that we don't diminish carbon emissions at the present time, this could spell a huge issue for our eating regimens. By the middle of the century around 175 million additional individuals have zinc insufficiency and 122 million individuals could become protein deficient because of these changes in plant physiology. This fundamental change in essential crops is a direct attack on our nutrition, which plays an elemental role in prolonging human life expectancy.¹⁷ The authors singled out income as a factor by classifying countries to yield constant and reliable results as far as possible. This is because income affects access to education, sanitation, healthcare, and diet, all of which play huge parts in extending or reducing human life expectancy. However, it is imperative to note that genetics, according to many scientists, plays an important role (about a third of variation in life expectancy is attributed to the genes: Apolipoprotein E (APOE), Forkhead box O3 (FOX03) and Cholesterylester transfer protein (CETP))¹⁸ in determining the expectancy of an individual and it acts as a limitation to the authors’ study. While the authors did divide the world into different regions and study them separately, which allowed them to factor race and thus genetics to a degree, it still caused complications when developing valid results. Another source of bias could be the classification system of warm and cold climates allocated to each country - countries such as the United States of America and China see many different climates across their nation and while the authors classified it based on majority, it doesn’t exclude the fact that discrepancies occurred. Japan is ranked as cold while Sardinia is as warm, but both are home to some of the oldest people around the world- this is due to their lifestyle factors which the authors accounted for when classifying data according to income groups, however, anomalies and variation do occur widely, such as in the case of Sardinia and Okinawa. The authors implore fellow scientists and researchers to conduct more trials to better determine the role of genetics irrespective of location and climate in affecting human life expectancy.
While conducting a thorough literature review of all the available studies on the topic of whether climate affects life expectancy, the authors came across multiple studies that further supported the results with concrete statistical and genetic evidence. A study conducted by economists from the Stanford University and the Massachusetts Institute of Technology in June 2019 collected extensive data over fifteen years of people who migrated after the age of 65 and those individuals who stayed in the same location their whole lives. This allowed them to factor out health, lifestyle, and genetics to isolate the effect of location on lifespan. The study found that life expectancy was lowest in the South of the United States (warmest parts of the country), and highest through the Upper Midwest (a much colder region).¹⁹ Additionally, according to researchers from the University of Michigan, worms that were introduced to colder temperatures triggered a genetic response that led to longer lifespans. The researchers believed that the probability of translating the same findings to humans is high since human beings have similar genetics. ²⁰ Following the same line of research, scientists at Scripps Research Institute in California reduced the internal body temperatures of warm-blooded animals like mice and found that this extended their lifespans by a substantial 20.0 percent.²¹ This is corroborating evidence to the study and falls in with the quantitative measured results. Finally, when addressing climate change, researchers at the National Institute of Environmental Health Sciences found that an increase of 1 degree Celsius in temperature, increased the death rate for elderly between 2.8 and 4.0 percent.²² This is consistent with the findings, when the authors say that it is crucial to act now and reduce global temperatures. The authors recognize individuals cannot move to colder geographic locations to theoretically increase the time they spend on this Earth. This is why the authors thought it vital to mention cold showers and cryotherapy. Most experiments that favor the effects of colder temperatures to increase life expectancy credit the explanation to either the free radical theory, or the fact that colder temperatures trigger genetic changes as observed in the study conducted at the University of Michigan. In such a case, taking cold showers or partaking in cryotherapy regularly could trigger changes in the genetic pathways over the long term that could allow an individual in a warmer climate to enjoy the same benefits their counterparts living in geographically colder climates do.
Conclusion It is clear from all data collected and quantified that individuals living in colder climates house longer-living individuals than their warmer climate counterparts. On average, when calculating the means of all life expectancies across all climate classifications and income groups, an individual may live an additional of 2.2163 years in colder regions while discrediting the role and involvement of genetics. The effects of climate change and warming of the Earth will therefore result in lower life expectancy. Further research and examination on the genetic impact of humans in different geographic locations would contribute meaningfully to this experiment. In addition, investigation of cryonics to extend the longevity of mankind, as well as preserve it can give this study a stronger grounding. Data collected and examined from research points towards the argument that human life expectancy can be extended by living in colder climates. Colder climates overwhelmingly display higher life expectancy in all four socio-economic country classifications.
Acknowledgements The authors would like to thank their parents for the constant support, and motivation and thank biology teachers: Mrs. Usha Devi and Mrs. Nandini Sreekumar for their valuable feedback and guidance when making the final edits to the paper.
Societies University of Nottingham Co-Responders: Going Green Teddy Bear Hospital Nottingham Paediatric Conference 2020 Palliative Care Society: A Look to the Future StreetDoctors
University of Nottingham CoResponders: Going Green Emma Midgley (CPD & Training Lead) and Elizabeth Gay (President) The last thing I’m thinking about on the way to a job is the climate. Will we be first on the scene? How sick is the patient likely to be? How bad is the traffic? How long will back-up take to arrive? Why didn’t I go to the toilet after the last job? Did I restock all the kit? Why is the traffic this bad on a Sunday at 8pm? Where in the heck in Nottingham are we?
As a volunteer for the University of Nottingham Co-Responders, I know that our minds tend to go toward tunnel vision. When we get the call to the 70-year-old with breathing difficulties or the 50-year-old in cardiac arrest, everything going through our heads is related to the job at hand. We don’t think about the emissions of our diesel response cars. We don’t think about the amount of waste we produce with the disposable kit we use. We don’t know what our carbon footprint is. We don’t think about it. But we should. The healthcare industry has a sizeable impact on the environment, anything up to 5% of the global total. Although the effect is small compared to other sectors, the carbon footprint of healthcare is only growing. The pandemic has seen considerable increases in disposable products used within and outside of healthcare and a massive rise in demand for healthcare resources. The time to start thinking about the future of sustainable healthcare is now. But we’re small fry. We’re a volunteer responder scheme helping East Midlands Ambulance service where we can – what could we possibly do to make an impact?
We can’t do much about our disposable kit except to ensure we don’t needlessly waste it. We can recycle where we can, but most of our disposables end up in clinical waste. Something we have little control over. What we do have some control over, however, is our cars. We’re currently relying upon two diesel Skoda Octavia’s, which contribute to the bulk of our schemes carbon footprint. Without our response vehicles, we couldn’t do what we do – but that doesn’t mean we have to kill the planet in the process. We are currently in the process of replacing our Skoda’s with fully electric Peugeot e2008s. But the replacement hasn’t been an easy journey – can we afford them? Where will we charge them? Can we get chargers put in for them? Where will we find the money? Our scheme relies entirely upon donations and charitable grants to keep itself running. The pandemic hit us hard by shutting down most of our usual fundraising activities. Whilst we’ve been able to raise some money here and there, it certainly wasn’t anything close to what we needed to afford the new cars. We managed to put enough together to cover the first year of the lease, allowing us to make the initial switch and place the order, but we don’t have a sustainable income to keep them running for the next three years. We want to reduce our carbon footprint, but we need your help to do it. If you can, please consider donating to UoNCR using our JustGiving page and help support our mission for a greener future. Thank you.
https://www.justgiving.com/fundraising/uonresponders
Teddy Bear Hospital Nottingham Paediatric Conference 2020 Lily Marrable (Research Co-Ordinator 20/21) and Lucy Ward (President 20/21) On 21st November 2020, Teddy Bear Hospital (TBH) successfully held Nottingham’s first ever National Paediatric Conference. In this article we will talk about the running of the day and how this event has been key in inspiring a future generation of paediatricians.
Teddy Bear Hospital: Who Are We? Teddy Bear Hospital is a community health education project for primary school children run by medical students. It aims to reduce childhood anxiety about hospitals and doctors and promote healthy living. A secondary aim of the society is to promote the specialty of paediatrics to current medical students.
The need for the event Unfortunately, there is currently a shortage of junior doctors entering the paediatric training programme in the UK, despite an increased need for paediatric doctors (1, 2). Paediatrics exposure in medical school is limited. At the moment, medical students at University of Nottingham undergo a paediatrics attachment in their fourth year; a useful introduction into the specialty, but there is limited time to highlight the vast opportunities paediatrics offers as a career. Moreover, currently paediatrics is introduced relatively late into the curriculum and as a society we feel that younger year groups could benefit from more insight into the specialty. As a result, Teddy Bear Hospital Nottingham decided to run a conference, primarily aimed at preclinical medical students, with the following aims: Promote paediatrics as a desirable specialty to medical students. 🧸 Provide opportunity for students who have completed research in paediatrics to present at a conference. 🧸 Offer networking opportunities with paediatric clinicians. 🧸
This was an entirely student-led initiative. We initially had envisioned the conference as an in-person event, but due to the COVID-19 pandemic, it was postponed and adapted to be an online conference delivered via Microsoft Teams. However, this brought some positive features, in particular its accessibility to medical students across the UK.
The day of the event We were delighted to assemble a programme with exciting talks from 10 guest speakers. The speakers ranged from consultant paediatricians of various subspecialities, a paediatric trainee, a speech and language therapist. Some of the topics covered included paediatrics as a career, global child health, how to become a paediatrician and how to communicate with children with Down syndrome. Three medical students from the University of Nottingham also had the opportunity to present their research projects in Child Health which they carried out as part of their BMedSci. Around 100 delegates joined us for the duration of the day. Delegates ranged from first year medical students all the way up to FY1 level (Figure 1). We welcomed students from University of Nottingham School of Medicine, Barts and The London School of Medicine and Dentistry, and Plymouth University Peninsula Schools of Medicine and Dentistry.
Figure 1. Stage of training of conference attendees, as indicated on the feedback form.
Feedback 96 of the delegates completed the anonymous online feedback form at the end of the conference. We were pleased to find that 94% of delegates felt that the conference had improved their “knowledge of the field of paediatrics”, with an average knowledge rating of 4.2/5 (very high level of knowledge) after attending the conference. Feedback commented on the excellence of the speakers, the insight it has provided delegates into the specialty, helpful advice on the application process, the success of using Microsoft Teams as the conference platform and the overall organisation and smooth-running of the day.
Dr Nathan, consultation community paediatrician and one of our guest speakers, said: “It was a privilege to be asked to speak at the recent Teddy Bear Hospital event. The event was extremely well run, online, with a range of speakers. Students were enthusiastic about careers in paediatrics and this was reflected in the questions.“
Overview Our primary aim was to promote paediatrics as a specialty, and from the feedback, it's clear that this was a success. Using Microsoft Teams as a platform worked really well, with multiple comments on how “smoothly” the conference ran.
This event has shown how successful online conferences can be and we would highly recommend other student societies to run similar events. Attending conferences like this are a great way of demonstrating enthusiasm for a specialty, or even just increasing awareness of different specialties.
Acknowledgements A sincere thank you to our incredible guest speakers who made this event possible. We would also like to extend our thanks to all the delegates who tuned in to the conference.
Palliative Care Society: A look to the future William Richards (Wellbeing Co-ordinator) As this issue of the NMSJ has looked towards the future of Medicine, it feels appropriate to write about one of the newest societies at the University of Nottingham. Palliative Care Society may only be a few months old, but we are very excited about what the future holds for us! As a group of medics going into our final year, we decided to set up the society to increase the awareness of Palliative Care amongst our fellow students. We realised that, although we had received some teaching, we did not know as much as we’d like about one of the most difficult aspects of being a doctor; dealing with patients approaching the end of their life.
What are we about? Therefore, led by our president, we decided to take the leap and establish our society. Our aim is to create an environment that encourages medical students to learn more about the evolving field of palliative care. Additionally, we want to explore the communication skills necessary when talking to patients and their families, to ensure they are treated with the dignity and respect they deserve. Finally, we set up the society as a space to share our thoughts and feelings. We hope that we can create a safe and supportive space to reflect on and discuss difficult experiences we may have seen on placement, as well as providing opportunities to network with doctors in the field and learn more about what drew them to palliative medicine.
We have already been fortunate enough to hold our first event with a registrar in palliative medicine. They discussed how best to support ourselves in difficult clinical situations and offered us tips on how to deal with challenging experiences we may come across in clinical practice. Looking forward, we have several future events lined up with palliative care specialists, as well as possible fundraising and volunteering opportunities on the horizon. So, if any of this sounds interesting to you, then please come and join us! We’re open to students from all years and would love for you to be a part of shaping our new society.
Facebook: https://www.facebook.com/UoNSUPallSoc/
Instagram: @uonpalliativecaresoc Email: palliative-care@uonsu.com
Street Doctors Simran Dhugga and Anjali Mehta Youth violence is a fundamental problem in many cities across our nation. Between September 2019 and September 2020, there were 47,119 offences involving knives or sharp objects recorded by the police in England and Wales (1). These offences have been rising since 2014 and although in recent years the rate of increase has slowed, even one offence is too many. The cost of this violence to the NHS is estimated at £2.9 billion each year (2). However, this value fails to account for the traumatic impact violence leaves not only on the victims and perpetrators but also on the wider community in which these offences take place. Young people exposed to violence within their family and community are more likely to be involved in violence themselves. Violence also leaves young people at greater risk of developing social and mental health issues (3). It is essential we empower young people to understand the impact of youth violence to not only prevent violence from happening but also to reduce the impact when it does.
It is from this need that StreetDoctors was founded in 2008. StreetDoctors is a charity that aims to empower individuals affected by violence to keep themselves and their communities safe. We do so by educating young people about the medical consequences of carrying weapons and explore their attitudes to violence. As well as this, we teach simple emergency first-aid, such as how to respond to an unconscious or bleeding person.
As a group of healthcare student volunteers, we work in partnership with a range of delivery partners, ranging from schools to community groups, and criminal justice organisations. This allows us to reach out to those most at risk of youth violence. There are currently 22 teams across 17 different cities in the UK and Ireland, and together we have taught over 18,000 individuals. Locally in Nottingham, we were able to teach 372 young people between 2019-2020. Ultimately, we hope to equip young people across the country with the confidence and practical skills they need to act as StreetDoctors in their own communities. In response to the COVID-19 pandemic, our approach to teaching has changed. We are now delivering teaching sessions over Zoom and have adapted our resources to an online platform to offer a similar level of interaction. Most of our volunteers have been trained to deliver teaching digitally through a series of workshops and have been well-supported through this process. Despite not being able to carry out face-to-face teaching, it has been wonderful to see the level of engagement young people have in the digital sessions and has led to a multitude of benefits. For example, we have noticed that some students have felt more confident to engage with the session and ask
questions due to the anonymised features available. As well as this, we have been able to work with other teams across the country to cover more geographical locations that may have otherwise not been feasible. In addition to our teaching, we try to promote the work of StreetDoctors to the wider public through our social media and fundraising activities. Our work has been featured on BBC Crimewatch and more recently on an episode of the Waiting Room podcast by Dr Alex George, the newly appointed government mental health ambassador. Despite barriers imposed by the pandemic, we have been able to organise bake sales and a running competition to help raise vital funds to continue the lifesaving work we do. If you are interested in keeping up to date with our activities or getting involved yourself please visit our social media pages listed below.
Instagram.com/streetdoctorsnottingham Facebook.com/StreetDoctorsNottingham
Stories and Views
Personal stories and views from life as a medical student Final Year, Final Hurdle
Final Year, Final Hurdle Natasha Harris
Ah, CP3. You are almost a doctor but still very much a medical student. There is a lot of responsibility, as you are expected to perform at the level of an F1 before you’ve even had a chance to submit your Oriel application. It often feels overwhelming, confusing and should really come with its own manual! And sure, us CP3s do have a handy study guide to help us but for those of you that are not there yet, here are my hints and tips for tackling final year. It’s the last hurdle to jump, sitting between you and becoming a doctor and it is never too early to start prepping.
1. Make a note of all important dates There’s no getting away from the fact that CP3 is chockfull of particularly important deadlines. You’re probably used to quickly jotting down the dates of your exams, which will come in handy with finals just around the corner but don’t forget about the other deadlines too! - Do you know when your application for the foundation programme needs to be submitted by? This is perhaps the most important date in CP3, which unfortunately changes every year. (All I can tell you is that you application will need to be submitting around September time) If you miss this deadline, your current application will not be considered, and you will need to apply again next year. To avoid this, be sure to check the most current copy of the foundation application handbook (a new one is released every year and is available to be downloaded for free from the UKFP website) for the most accurate deadline date and don’t leave the submission until the last minute.
- Are you applying for the specialised foundation programmes? Those of you keen on getting more experience in research, education or leadership may choose to also apply to the specialised foundation programme or the SFP. If your application is successful, instead of rotating though 6 specialties during F1 and F2, you’ll rotate through 5 and have a protected academic placement.
This, of course, means more dates to remember and just like before, the dates will change from year to year. Each UoA (or Unit of Application- essentially a group of foundation schools that you apply to) has its own dates for sending out interview invitations and carrying out the said interviews. Make sure you check the dates you are interested in by going to the specific UoA website and if you’re lucky enough to get an interview, book a date that works for you early on, as those slots fill up very quickly!
2. Try to take on more clinical responsibility In a year’s time, you’ll be expected to review patients by yourself and while there should always be a senior to escalate to, they may only be available via the phone! So, I believe it is extremely important that you start to take on little bits of responsibility while on placement. While you should never act beyond your scope or do something you are not completely comfortable with, there are plenty of things you can do as a CP3 to get more involved. While on GP placement, ask your GP supervisor if they would be happy to let you see patients by yourself. This is fantastic way to build your confidence and will really make you feel like an actual doctor. By the end of the rotation, you may even be allowed to hold your own mini clinics!
Once you’ve been shown how to perform venepuncture and canulate patients on a mannequin, try to practice these skills on real patients. If a patient is happy for a student to carry out the procedure and you have a suitable medical professional supervising you, you’ll be building on vital skills and helping the team at the same time. During your surgery placement, make sure to do some information gathering before asking the surgeon if you can scrub in with them. Speak to the patient, letting them explain why they are having the operation and find out if they have already had their pre-op anaesthetic assessment. Also, be sure to read up on the surgery itself and be confident in your anatomical knowledge - the surgeon may very well be impressed if you can answer their questions! If you at a loss at what to do on the wards, you can always ask the F1 or F2 if they need help with writing any discharge summaries. Since ensuring TTOs are written in a timely fashion will be your responsibility as a junior, this a key skill for you to master in CP3.
3. Remember that finals are not the only exams you need to pass in CP3 - When revising for your MCQs and OSCEs, spare a thought for the SJT and PSA. - Have you booked your SJT slot? Have you completed the official PSA practice papers? Will you be sitting both exams at home or in a test venue?
- Will be benefit from doing the Passmed questions for the PSA or would you benefit more from attending a paid SJT prep course? - With so many people focused on finals, be the candidate who gives as much focus to your other CP3 exams, and I guarantee you will find the year stressful. - Finally, plan your SJT date carefully. Do you want to sit the exam in December and get it out of the way so that you can focus on the PSA or would prefer to have the extra revision time and sit it in January? Both options are equally valid, and you need to figure out what would work best for you, keeping in mind that you may also have your specialised foundation programme interviews to plan around.
4. If you ever get overwhelmed... - You have people whose very job is to help you: 1. Contact your personal tutor with any concerns or arrange an appointment with the university counselling team. 2. If you’re more comfortable talking to a peer, each year group has MedSoc volunteers who provide a great and confidential service. Even if you think your problems are too small to bother anyone with, remind yourself that your safety and emotional wellbeing should a priority during this challenging period. So never be afraid to admit that you may need a little help, we all need a helping hand from time to time.
And finally, remember, you’ve made it this far - foundation training is just around the corner!
Creatives
Jasmine Plummer
An Ode To What Once Was Laxmi Prashamsa Manchiraju
The arteries of the Earth run dry, the mercury soars, and temperatures rise high. To treat you and me, a prescription, and a wet cloth to the head no such cure exists, to rid the Earth of the black smog it was fed. The smoke bled into the sky, the fires ravaged, and the storms swept Swept away homes, burned down lives and choked our dreams as we slept
Down the blue corridors, the white coats lifted a weary gaze on this mounting trade from curing ailments of nature to those man-made. Every day they hobble over the parched earth and stagger past leafless skeletons, rush past the hungry they can’t feed and the dying they can’t save till at last they’re inside, facing no one else but each other. There used to be one more amongst them, a ghost of the past - a small hope, a tether to the days gone by, of green, blue, and vivid warm colour. They hoped for change, before it was too late but change never came and sealed was fate. Letters to the past, to us - you and me - they now pen in vain, as a plea to conserve and save, to slow down and to pause, lest we follow them in writing, a longingly remorseful ode, to what once was
Catherine Furlong
He Remembered Aymen Dar
He remembered the small things now, The smile on his dad’s face as he made it home, Just in time for the football game, The way his teddy bear sat, lopsided on the bed, He’d never admitted to his mum, That it had always been his favorite gift, The crying of his sister for every little thing, But then she’d gifted him her best crayon, And all was well. He sipped at the hot tea, Big cup clasped in his tiny hands, Sapping what warmth he could get. He remembered how just last week, He hadn’t let his mum finish packing his lunch, Insisting that he’d be late for the party, Insisting they just stay and watch a movie, Because he was a big boy now, He could walk to the park alone. The flash came in an instant, Loud voices, phones gripped in hands, Bustled into a car, wanting to go home, But home was back there, Where the fire was chasing them from.
And the burning, so much fire, So much red and yellow and flames that wouldn’t let go, Nobody would let him go, find his family and be safe and sound, Because back there, The trees were all shriveled up stumps, And the teacher had said, Even the squirrels were gone.
He’d stare out the small window, In the school gym, Watch the adults pace, Whispers at night when the others were sleeping, But he didn’t close his eyes, He didn’t want to see those things again. It hurt. He watched as the other kids, As they laughed and played. Wishing every morning, as another day begun, That he could have stopped this nightmare, He could have done something, anything, He could have....
A tap on his shoulder, another weak smile, Some words spoken, And finally, a single piece of paper, crinkled in his hands. Quietly, he took his crayon, from beneath the safety, And warmth of his pillow, And he began to draw.
Jasmine Plummer
Turn Before the Brink Shumile J Chishty
The mining companies won’t let the trees be free Smoking through the pipes of bark Inhaling all the cash Exhaling a thick sooty mark They then grab the oils As they ignite their desires Throwing their bait of petrol, diesel, and gas Reeling in a host of pocket bulging buyers
As oils burn, gases are wafted up Like unwanted guests they hang within our lungs Setting up a room Then leaving the inside a mess, all the furniture tossed and flung The mess scatters to the bustling airways And a traffic jam of air begins to flood Mucus blocking the path Trapping the vehicles of oxygen like an absorbent mud
Narrowing the airways Starts a monotonous chain Echoing, Wheezing, beeps Leading to a rebellious cough to clear the congested lanes
Our bodies are so delicate So vulnerable to a guest Just some pollutants sightseeing through the bloodstream A small visit that can leave the vessels stressed
Rising heat is the cheating merchant Offering a jacket to the World to keep it snug Yet sneakily stuffing its pockets with disease Letting illness thrash health like a gang of thugs Some of these outlaw sneak in masks While others arrive making a wounding show bacteria and viruses are just a few Who set off to spread and grow?
It’s a flight to doom Where seatbelt signs fluoresce in their spots But we’ll struggle to fasten As companies pilot us into a physiological knot A knot so tight where no needle can tug it loose we’ll be drying like abandoned rope in a blistering heat, struggling to thrive, waiting for use
But before we reach the tipping point Where we'll see no return Let's turn back now Before health becomes a privilege we will yearn
References Climate change •
• •
• • • • • • •
Carlson, C., Farrell, M., Grange, Z., Han, B., Mollentze, N., Phelan, A., Rasmussen, A., Albery, G., Bett, B., Brett-Major, D., Cohen, L., Dallas, T., Eskew, E., Fagre, A., Forbes, K., Gibb, R., Halabi, S., Hammer, C., Katz, R., Kindrachuk, J., Muylaert, R., Nutter, F., Ogola, J., Olival, K., Rourke, M., Ryan, S., Ross, N., Seifert, S., Sironen, T., Standley, C., Taylor, K., Venter, M. and Webala, P. (2021) The future of zoonotic risk prediction. Philosophical Transactions of the Royal Society B: Biological Sciences, 376(1837) 20200358. Confalonieri, U., Margonari, C. and Quintão, A. (2014) Environmental change and the dynamics of parasitic diseases in the Amazon. Acta Tropica, 129, 33-41. ELLWANGER, J., KULMANN-LEAL, B., KAMINSKI, V., VALVERDE-VILLEGAS, J., VEIGA, A., SPILKI, F., FEARNSIDE, P., CAESAR, L., GIATTI, L., WALLAU, G., ALMEIDA, S., BORBA, M., HORA, V. and CHIES, J. (2020) Beyond diversity loss and climate change: Impacts of Amazon deforestation on infectious diseases and public health. Anais da Academia Brasileira de Ciências, 92(1) e20191375. Gibb, R., Franklinos, L., Redding, D. and Jones, K. (2020) Ecosystem perspectives are needed to manage zoonotic risks in a changing climate. BMJ 371 3389. Keesing, F., Belden, L., Daszak, P., Dobson, A., Harvell, C., Holt, R., Hudson, P., Jolles, A., Jones, K., Mitchell, C., Myers, S., Bogich, T. and Ostfeld, R. (2010) Impacts of biodiversity on the emergence and transmission of infectious diseases. Nature, 468(7324) 647-652. Min, K., Schneider, M. and Cho, S. (2020) Association between predator species richness and human hantavirus infection emergence in Brazil. One Health, 11 p.100196. Rubio, A., Ávila-Flores, R. and Suzán, G. (2014) Responses of Small Mammals to Habitat Fragmentation: Epidemiological Considerations for Rodent-Borne Hantaviruses in the Americas. EcoHealth, 11(4) 526-533. White, R. and Razgour, O. (2020) Emerging zoonotic diseases originating in mammals: a systematic review of effects of anthropogenic land‐use change. Mammal Review, 50(4) 336352. Wu, X., Lu, Y., Zhou, S., Chen, L. and Xu, B. (2016) Impact of climate change on human infectious diseases: Empirical evidence and human adaptation. Environment International, 86 14-23. Wu, X., Lu, Y., Zhou, S., Chen, L. and Xu, B. (2016) Impact of climate change on human infectious diseases: Empirical evidence and human adaptation. Environment International, 86 14-23.
Curriculum Development 1. Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Belesova K, Boykoff M, Byass P, Cai W, Campbell-Lendrum D, Capstick S, Chambers J, Dalin C, Daly M, Dasandi N, Davies M, Drummond P, Dubrow R, Ebi KL, Eckelman M, Ekins P, Escobar LE, Fernandez Montoya L, Georgeson L, Graham H, Haggar P, Hamilton I, Hartinger S, Hess J, Kelman I, Kiesewetter G, Kjellstrom T, Kniveton D, Lemke B, Liu Y, Lott M, Lowe R, Sewe MO, Martinez-Urtaza J, Maslin M, McAllister L, McGushin A, Jankin Mikhaylov S, Milner J, MoradiLakeh M, Morrissey K, Murray K, Munzert S, Nilsson M, Neville T, Oreszczyn T, Owfi F, Pearman O, Pencheon D, Phung D, Pye S, Quinn R, Rabbaniha M, Robinson E, Rocklöv J, Semenza JC, Sherman J, Shumake-Guillemot J, Tabatabaei M, Taylor J, Trinanes J, Wilkinson P, Costello A, Gong P, Montgomery H. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. The Lancet. 2019;394(10211):1836-1878. doi:10.1016/s0140-6736(19)32596-6 2. Mortimer F. Sustainable Healthcare Education Case Studies 2016-17. Centre for Sustainable Healthcare, Healthy Planet UK networks.sustainablehealthcare.org.uk/networks/sustainablehealthcare-education/sustainable-healthcare-education-case-studies-2016-17. Retrieved 2020, from networks.sustainablehealthcare.org.uk/networks/sustainable-healthcareeducation/sustainable-healthcare-education-case-studies-2016-17. Accessed March 19, 2021. 3. Tun (May Sanyu Tun) S, Wellbery C, Teherani A. Faculty development and partnership with students to integrate sustainable healthcare into health professions education. Medical Teacher. 2020;42(10):1112-1118. doi:10.1080/0142159x.2020.1796950
4. Planetary Health Report Card. Planetary Health Report Card. https://phreportcard.org. Published 2021. Accessed May 13, 2021. 5. Hopkins C. Planetary Health Report Card: University of Nottingham. Phjrc.files.wordpress.com. https://phjrc.files.wordpress.com/2021/04/nottingham-planetaryhealth-report-card-2021.pdf. Published 2021. Accessed May 13, 2021.
The Development of a Malaria Vaccine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227679/ https://www.who.int/news/item/06-10-2021-who-recommends-groundbreaking-malaria-vaccine-for-children-atrisk https://almostadoctor.co.uk/encyclopedia/malaria https://en.wikipedia.org/wiki/Malaria
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00943-0/fulltext https://www.weforum.org/agenda/2021/10/world-s-first-mass-malaria-vaccine-rollout-could-preventthousands-of-children-dying/
StreetDoctors 1. Statistics OfN. Crime in England and Wales: year ending September 2020. 2021. 2. Observatory NWPH. 2012 2012. 3. Clissold-Lesser S. Young People are part of the answer to preventing and reducing violence – we just need to believe in them. Magistrates Magazine 2021.
Teddy Bear Hospital Conference 1. Cass H, Barclay S, Gerada C, et al. Complexity and challenge in paediatrics: a roadmap for supporting clinical staff and families. Archives of Disease in Childhood. 2020; 105(2): p. 109-114. 2. Royal College of Paediatrics and Child Health. Shortage of consultant paediatricians in the UK. London, Workforce team; November 2019.
Exploring Human Longevity 1. “Life Expectancy at Birth.” Charting the Progress ofPopulations, United Nations, 2000, pp. 45– 49. 2. Mandal, Dr. Ananya. “Life Expectancy VersusLifespan.” News, 27 Feb. 2019, www.newsmedical. net/health/Life-Expectancy-Versus-Life-Span.aspx. 3. Angel, J. Lawrence. “The Bases of Paleodemography.” Wiley Online Library, John Wiley & Sons, Ltd, 2 June 2005, onlinelibrary.wiley.com/doi/abs/ 10.1002/ajpa.1330300314. 4. “Life Expectancy.” World Health Organization, World Health Organization, 15 May 2018, www.who.int/gho/mortality_burden_disease/life_ tables/situation_trends_text/en/. 5. “World Population Prospects: The 2017 Revision| Multimedia Library - United Nations Department of Economic and Social Affairs.” United Nations, United Nations, 2017, www.un.org/development/desa/publications/worldpopulation-prospects-the-2017-revision. 6. 5 "Blue Zones" Where the World's Healthiest People Live, 10 Apr. 2017, www.nationalgeographic. com/books/features/5-blue-zones-where-theworlds-healthiestpeople-live/. 7. “The Health Benefits of Living in a Warm Climate.” Britannia Movers International, 27 May 2016, www.britannia-movers.co.uk/emigration-blog/healthbenefits-living-warm-climate. 8. Hatfield, Dolph L. “Redox Pioneer: Professor Vadim N. Gladyshev.” Antioxidants & Redox Signaling, vol. 25, no. 1, 2016, pp. 1–9., doi:10.1089/ars.2015.6625.. 9. Ognibene, Alex. Blue Zones. 16 Aug. 2019. 10.International Actuarial Association, 2017, Climate Change and Mortality. 11. United Nations, Department of Economic and Social Affairs, Population Division (2019). World Mortality 2019: Data Booklet (ST/ ESA/SER.A/436). 12.“Country Classification.” United Nations, 2019, www.un.org/development/desa/dpad/wpcontent/ uploads/sites/45/WESP2019_BOOK-ANNEX-en.pdf.
13. “Global Warming Effects.” Global Warming and Climate Change Effects: Information and Facts, 4 Feb. 2019, www.nationalgeographic.com/ environment/global-warming/global-warmingeffects/. 14. Campbell-Lendrum, Diarmid, and Annette PrüssUstün. “Climate Change, Air Pollution and Noncommunicable Diseases.” World Health Organization, World Health Organization, 31 Jan. 2019, www.who.int/bulletin/volumes/97/2/18-224295/en/. 15. “Heatwaves.” World Health Organization, WorldHealth Organization, www.who.int/health topics/heatwaves. 16.O'Brien, Jane. “Rising CO2 Is Making Food Less Nutritious " Yale Climate Connections.” Yale Climate Connections, 16 Feb. 2018, www.yaleclimateconnections.org/2018/02/rising-co2is making-food-less-nutritious/. 17. Beach, Robert, et al. Elsevier Ltd, 2019, pp. 1–11, Combining the Effects of Increased Atmospheric Carbon Dioxide on Protein, Iron, and Zinc Availability and Projected Climate Change on Global Diets: a Modelling Study. 18. “Is Longevity Determined by Genetics? - Genetics Home Reference - NIH.” U.S. National Library of Medicine, National Institutes of Health, 7 July 2020, ghr.nlm.nih.gov/primer/traits/longevity. 19. Finkelstein, Amy, et al. 2019, pp. 1-74, PLACEBASED DRIVERS OF MORTALITY: EVIDENCE FROM MIGRATION. 20. Xiao, Rui. Cell Journal, 2015, pp. 1–12, A Genetic Program Promotes C. Elegans Longevity at Cold Temperatures via a Thermosensitive TRP Channel. 21.Conti, Bruno. “New Research Reveals Pathway for Anti-Aging Therapies.” New Research Reveals Pathway for Anti-Aging Therapies | Scripps Research, 2017. 22. “Is Longevity Determined by Genetics? Genetics Home Reference - NIH.” U.S. National Library of Medicine, National Institutes of Health, 7 July 2020, ghr.nlm.nih.gov/primer/traits/longevity.