International Medical Research Research Articles

Project-based faculty development: Indian perspectives.

Faculty development (FD) is considered a vital input to maintain and improve the quality of teaching.[1] In developing countries like ours, the challenge is 2-fold – on one hand, there is shortage of medical schools to produce the required number of graduates and on the other hand, unprepared teachers are not able to deliver quality medical education. The issue has warranted attention since last many years and culminated in the establishment of National Teacher Training Centers (NTTCs) at 5 medical schools in the country in 1976. These NTTCs used to impart a 6–10 days long program covering various aspects of teaching and learning.[2] However, most of these courses were one contact courses, without much follow-up, although at some places, the concept of a project work was introduced. There were some gains in terms of many teachers opting for these courses and later duplicating them in their own institutions. However, there was no proper follow-up of these programs in terms of documenting their impact or effectiveness. Over the years, many other institutions like All India Institute of Medical Sciences, New Delhi also ventured into this area with a focused approach like assessment. A large number of teachers were “trained,” but again the content delivery remained limited to the contact sessions only, with hardly any follow-up. The Medical Council of India in its 1997 regulations also mandated the establishment of medical education units in each college, which were required to conduct in-house training sessions.[3] Most of the times, these sessions were a replication of the training received at NTTCs or other avenues and got standardized as a 3 day workshop format, with a day each being devoted to objectives, teaching learning and assessment. FD is an expensive affair with both direct and indirect costs contributing to the burden. Its equivalent – human resource development – is often used in the industry as a means to maintain quality and the impact is often monitored. The utility of any program will manifest only if the participants take the knowledge and skills back to the workplace. This process called transfer of training is crucial for the success of any such initiative. It is estimated that not more than 20% of what is learned is actually used at the workplace.[4] We do not have any data for FD, but it is reasonable to assume that the figure would not be more than this. There are many reasons for the lack of transfer,[5] the prominent ones being training which is conceptually different from actual working conditions. In the year 2005, Foundation for Advancement of International Medical Education and Research (FAIMER) established its first regional institute (FRI) for FD in Mumbai, followed by one in 2006 in Ludhiana. The curriculum used in FRIs was different from the programs being offered till now,[6] in the sense that it was a longitudinal program spanning over 2 years (and even longer if the participant so desired) and emphasized the importance of educational networking and educational leadership, in addition to basing its curriculum on project-based learning model. An educational innovation project is an essential component of FAIMER training (in addition to being one of the selection criteria). The fellows propose the outline of an innovation project with their application. During the contact sessions, the faculty and peers help them to modify their project in an implementable shape. A large chunk of training is devoted to project management and evaluation with use of program evaluation tools. It is based on the assumption that carrying out the project will provide the fellows an opportunity for hands on applying what they learn. In addition, it will also bring visibility to the efforts being made across various institutions. The regulatory authority of medical education in India – Medical Council of India – also gave an impetus to FD by initiating a nationwide FD program in 2009 named as basic course,[7] with the objective of covering almost 100% of the medical teachers to basic concepts of education. The program was well accepted and 5 years down the line, over 20,000 teachers have been covered. Encouraged by the success, the Medical Council of India came out with an advanced course, now renamed as Fellowship in Medical Education in 2014,[7] which again is based on the concept of project based learning. In this special issue of the journal on the theme of “Innovations in Medical Education Technology,” you will find examples of various innovative projects carried out by fellows for one of these programs. They may not be as rigorous as randomized controlled trials, but they indicate a trend of change and a small effort by enthusiastic teachers to make medical education better so that it can help us to produce a healthy India.

Mental illness in Saudi Arabia: an overview.

Mental illness in Saudi Arabia: an overview.

Paper versus device – which has a greater impact on the medical student’s performance?

Introduction: Technology, a growing field, has been closely linked with productivity during the second half of the 1990s. According to Gorman (2014), there were ‘ new estimates of the role of technological change in the unusual increases in measured productivity’ . This research aimed to study the impact of technology on medical students’ performance. Objectives: First, the study aimed to identify the educational tools used among medical students. Second, to evaluate the different learning styles among medical students by using Kolb’ s version 3.1 (HayGroup®, Philadelphia, PA, USA). The third and fourth objectives referred to acknowledgement of impact of educational tools and learning style on grade point average (GPA). Materials and methods: A quantitative study was performed by creating online surveys for medical students in fourth, fifth and sixth years of study in order to focus on clinically oriented students. The sample size was random and 147 out of 254 students completed the survey. Results: The chosen measurable tool, GPA, did not have a direct impact on the students’ performance. However, it showed that students with an A average GPA used smart devices more than paper-based material, and in comparison with students with a C average GPA who used paper-based material more. Regarding Kolb’ s, it showed that most medical students are considered ‘ Convergers’ , which simply means that they think about the problem, understand it and then try to solve it. Furthermore, the majority of medical students believe that smart devices will have a greater impact on medical education in the future. Conclusions: This study aims to encourage universities to provide free access to ebooks, journals and educational videos to medical students. Acknowledgements: We would like to thank King Abdullah International Medical Research Center and National Guard Health Affairs for giving us the opportunity to work on a research project during the summer. We would also like to thank the biostatisticians who helped organizing our data and tables. Most importantly, we acknowledge each medical student who completed our survey, because without them we would not have any research data.

Stem cell research and regenerative medicine at King Abdullah International Medical Research Center.

Translation of stem cell research from bench to bedside opens up exciting new therapeutic options for patients. Although stem cell research has progressed rapidly, its clinical applications have not kept pace. We report on the establishment of a stem cell research and regenerative medicine program at King Abdullah International Medical Research Center (KAIMRC). The purpose of this unit is to coordinate advanced stem cell research and translational outcomes with the goal of treating chronic human diseases, such as cancer, diabetes, cardiovascular, neurological, immunological, and liver diseases. Our first step in achieving this goal was to integrate the stem cells and regenerative medicine unit with our umbilical cord blood bank and bone marrow registry. This organizational structure will provide different sources for stem cells for research and clinical purposes, and facilitate our stem cell research and stem cell transplantation program. We are at an early and exciting stage in our program, but we believe that our progress to the international stage will be rapid and have a significant impact.

Prospective study of incidence and predictors of peripheral intravenous catheter-induced complications.

BackgroundAlthough intravenous therapy is one of the most commonly performed procedures in hospitalized patients, it remains susceptible to infectious and noninfectious complications. Previous studies investigated peripheral intravenous catheter (PIVC) complications mainly in pediatrics, but apparently none were investigated among Saudi adult populations. The aim of this study was to assess the pattern and complications of PIVCs at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia.MethodsAn observational prospective cohort study investigated PIVCs pattern and complications among adults with PIVCs, admitted to various wards at KAMC. PIVCs-related clinical outcomes (pain, phlebitis, leaking, and others) were recorded in 12-hour intervals, using the Visual Inspection Phlebitis scale. Density incidence (DI) and cumulative incidence (CI) of complications and their relative risks (RRs) were calculated. Regression analyses were applied and significance limits were set at P<0.05.ResultsDuring the study period, 359 adults were included, mounting to 842 PIVCs and 2,505 catheter days. The majority of patients, 276 (76.9%), had medical, chief admission complaints, whereas 83 (23.1%) were trauma/surgical and infectious cases. Complicated catheters were found in 141 (39.3%) patients, with 273 complications (32.4/100 catheters), in 190 complicated catheters (CI =22.56/100 catheters and DI =75.84/1,000 catheter days). Phlebitis ranked first among complications, 148 (CI =17.6%), followed by pain 64 (CI =7.6%), leaking 33 (CI =3.9%), dislodgement 20 (CI =2.4%), and extravasations and occlusion 4 (CI =0.5% each). Phlebitis was predicted with female sex (P<0.001), insertion in fore/upper arm (P=0.024), and infusion of medication (P=0.02). Removal time for PIVCs insertion was not a significant predictor of phlebitis (RR =1.46, P=0.08).ConclusionIncidence of complications in this study was significantly higher than rates in previous studies. Better insertion techniques may be sought to lower the incidences of PIVC complications, thus extending their onset beyond day 3. Changing catheters is recommended when clinically indicated rather than routinely post-72 hours.

Welcome message from conference co-convenors.

We are delighted to welcome our international and national presenters, delegates from cancer research groups in Australia and across the world, and our generous sponsors to the fourth Sydney Cancer Conference (SCC2014), hosted by the University of Sydney Cancer Research Network (CRN). The CRN currently has more than 800 members ranging from PhD students to leaders of major research programs across multiple disciplines. The theme of our biennial conference is ‘Bridging Research and Practice’, which recognises the rapid advances being made in basic research and the need for their translation from the bench to the beside and also translation of the evidence generated into clinical practice. We wish to welcome our eminent keynote speakers: Professor Sir David Lane, Chief Scientist, A*STAR and Director p53 Laboratory, Singapore; Professor Eva Grunfeld, Vice-Chair Research, University of Toronto, Canada; Professor Fiona Watt, Director, Centre for Stem Cells and Regenerative Medicine, King's College London, UK; and Professor Dennis Lo, Director, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong. Australian scientists make a disproportionately high contribution to international health and medical research and this is reflected in the number of national speakers at SCC2014. The conference will open with a public lecture delivered by Professor Ian Frazer (Chief Executive Officer and Director of Research, Translational Research Institute, Brisbane, Australia) and each of the conference's themes is carried forward by distinguished national speakers. Invited posters will be on view during the conference with the main viewing session at our cocktail function on Thursday night. Our workshops on ‘Career hints for postgraduates’ and ‘Talking to commercial partners – when and how?’ further complement our program. Early career researchers and postgraduate students will be in the running for oral and poster awards in recognition of quality research. A panel discussion on Friday afternoon will address the topic ‘Smashing silos, building bridges – is multidisciplinary research delivering on its promise?’ We aim through this forum, with active delegate participation, to debate key translational research questions and thereby help direct our efforts towards greater impact. The panel will be chaired by ABC broadcaster and University of Sydney's Ambassador for Mathematics and Science, Adam Spencer. His humour and scientific insights will make for a fascinating panel discussion. It has been our privilege to convene this conference. Our sincere thanks, to the conference organising committee and in particular Merilyn Heuschkel, Executive Officer, Cancer Research Network, for their dedication and hard work in creating an excellent scientific program. SCC2014 was been supported by a number of sponsors to whom we are very grateful. Please take the time to visit their exhibition stands and read the information in your conference satchels from our supporters. We welcome you to Sydney and hope that this year's conference will challenge and inspire you, and result in new knowledge, collaborations, and friendships.

Retraction: notice.

Ping Gao, Shun-Chang Jiao, Li Bai, et al. 'Detection of circulating tumour cells in gastric and hepatocellular carcinoma: A systematic review' Journal of International Medical Research August 2013 vol. 41 no. 4 923-933. DOI: 10.1177/0300060513489789 has been retracted. This is because it contains unattributed overlap with material from the following article: FC Bidard, FR Ferrand, F Huguet, et al. 'Disseminated and circulating tumor cells in gastrointestinal oncology' Critical Reviews in Oncology / Hematology, Volume 82, Issue 2, Pages 103-115, May 2012. DOI: 10.1016/j.critrevonc.2011.05.008 NOTICE: Yongsheng Zhao, Yuxin Liu and Yanping Zheng, 'Osteoporosis and related factors in older females with skeletal pain or numbness: A retrospective study in East China', Journal of International Medical Research June 2013 vol. 41 no. 3 859-866. DOI: 10.1177/0300060513483414 has been retracted. This is because it contains unattributed overlap with material from the following article: Shasha Li, Hongchen He, Mingfu Ding et al. 'The correlation of osteoporosis to clinical features: a study of 4382 Female Cases of a Hospital Cohort with musculoskeletal symptoms in Southwest China' BMC Musculoskeletal Disorders 2010, 11:183. DOI: 10.1186/1471-2474-11-183 NOTICE: Ao Qiang Guo, Lei Sheng, Xu Lei et al. 'Pharmacological and physical prevention and treatment of no-reflow after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction' Journal of International Medical Research June 2013 vol. 41 no. 3 537-547. DOI: 10.1177/0300060513479859 has been retracted. This is because it contains unattributed overlap with material from the following article: Giampaolo Niccoli, Rajesh K Kharbanda, Filippo Crea, et al. 'No-reflow: again prevention is better than treatment' European Heart Journal (2010) 31(20): 2449-2455. DOI: 10.1093/eurheartj/ehq299.

Notice

Ying-Li Lin, Jian-Hua Ma, Xiang-Li Luo, et al. ‘Clinical significance of protocadherin-8 (PCDH8) promoter methylation in bladder cancer’, Journal of International Medical Research February 2013 vol. 41 no. 1 48–54. DOI: https://doi.org/10.1177/0300060513475571contains material which overlaps with a previously published article. Readers are referred to:YL Lin, ZG Li, ZK He, et al. ‘Clinical and Prognostic Significance of Protocadherin-10 (PCDH10) Promoter Methylation in Bladder Cancer’, Journal of International Medical Research December 2012 vol. 40 no. 6 2117–2123. DOI: 10.1177/030006051204000609 HF Zhang, KJ Zhao, PF Yang, et al. ‘Association between Fibroblast Growth Factor Receptor 4 Gly388Arg Polymorphism and Ischaemic Stroke’ Journal of International Medical Research October 2012 vol. 40 no. 5 1708–1714. DOI: https://doi.org/10.1177/030006051204000509contains material which overlaps with a previously published article. Readers are referred to:Lan Ma, Haifeng Zhang, Carrie Han, et al. ‘Fibroblast Growth Factor Receptor 4 Polymorphisms and Susceptibility to Coronary Artery Disease’ DNA and Cell Biology. June 2012, 31(6): 1064–1069. DOI: 10.1089/dna.2011.155 Bai H, Jing D, Guo A et al. ‘Association between interleukin 10 gene polymorphisms and risk of type 2 diabetes mellitus in a Chinese population’ Journal of International Medical Research June 2014 Vol. 42 no.3 702–710. DOI: https://doi.org/10.1177/0300060513505813.The first affiliation was listed incorrectly. It should have read:1First Affiliated Hospital of the General Hospital of the People’s Liberation Army, Beijing, ChinaThe authors apologise for this error.

Improving cord blood unit quantity and quality at King Abdullah International Medical Research Center Cord Blood Bank

Public cord blood banks (CBBs) store cord blood unit (CBU) donations for anyone in need. However, strict regulations need to be followed to build up high-quality bank products that can be used worldwide. We established a public CBB at a tertiary hospital in Saudi Arabia. Here, we investigated the reasons behind rejecting or not collecting CBUs over 2 years (2011-2012) and which steps were implemented to improve the number and quality of storable units. A total of 2891 mothers were evaluated. Reasons for rejecting donors, not collecting, and rejecting units before or after collection were analyzed and compared for the years 2011 and 2012. A total of 1157 (40%) CBUs were not collected, mainly due to staff availability, and 564 (20%) CBUs were rejected. The main reason for rejecting donations was the mother's or neonate's health. Rejecting CBUs after collection was due to low volume. A total of 1170 (40%) CBUs were successfully collected for potential banking and sent for processing; however, 58% were rejected in the laboratory due to low total nucleated cell counts. Several changes were implemented during the 2 years including physician education and awareness, in utero collection, cesarean collection, and staff recruitment. These changes positively affected the numbers of our collected units. Out of the initially eligible mothers in 2011, only 17% were banked; this was increased to 33% in 2012. We identified the problems with collecting CBUs for banking and will keep improving our selection process of recruiting more CBUs of high quality.

Corrigendum

The authors would like to bring attention to the error published in 'Bioavailability of paracetamol, phenylephrine hydrochloride and guaifenesin in a fixed-combination syrup versus an oral reference product' 'Annick Janin and Joelle Monnet' Journal of International Medical Research 42(2) pp. 347-359. DOI: 10.1177/0300060513503762.

Acute liver failure in Turkey: a systematic review.

To present the causes of acute liver failure in Turkey. [corrected] International and national medical research databanks were searched for publications related to acute liver failure and originating from Turkey. Patients in the databank of acute liver failure of our center were also added to this literature search. Patients were evaluated for age, gender, etiology, treatment modality, and outcomes. A total of 308 patients were analyzed. Hepatitis A (20.9%) for children and hepatitis B (34.7%) for adults were the most common causes of acute liver failure. Cryptogenic (18%) and metabolic (14%) reasons were the followings. Wilson's disease was the most common cause of metabolic diseases. Mushroom intoxication was the most frequent factor of toxic liver failure for both adults and children (13%). Firework intoxication, including yellow phosphorus, is an indigenous factor. Anti-tuberculosis agents (3.2%) were the main cause of drug-induced acute liver failures (9%). Paracetamol was responsible for only 0.7% of all acute liver failures. Survival of the transplanted patients (n=118) was better than the non-transplanted patients (n=178) (65% vs. 36% respectively, p<0.001) CONCLUSION: Preventable causes of acute liver failure in Turkey include hepatitis viruses and intoxication. Active vaccination and public awareness can decrease the number of acute liver failures. Paracetamol is not an emerging reason for acute liver failure in Turkey now, but selling it over the counter may increase the risks.

The Informal Caregiver: A Qualitative Assessment of Needs and Requirements

Background: The centralisation of many medical services to hospitals in larger centres, as well as the cost consciousness of patients and medical insurers alike, has led to an increased necessity to travel nationally to seek medical treatment. This phenomenon is observed in New Zealand and world-wide. This is not unlike international medical tourism but research into the needs and requirements of the informal caregiver, accompanying the patient, has been neglected. Methods: Informal caregivers (IC), accompanying a patient for 2 or more days to receive medical treatment were recruited from private and public medical service providers in Dunedin, New Zealand. A semi-structured interview producing in-depth information to profile the visitor demographics and to explore the nature of their visit and their experiences was constructed. The qualitative material was screened for similarities and contradictions and analysed taking the situation of the support person and the environment into account. Results: Five participants were ICs of patients in private treatment; one participant accompanied a patient to a publicly funded treatment. ICs stayed for 2 days to 5 weeks. In the private sector no assistance was offered to help with basic requirements such as travel and accommodation although this was funded and therefore arranged for in the public sector. All IC critically missed interaction with other IC and most were interested in local attractions. Conclusions: This research shows that service provision for medical tourists at least in the private health care sector is solely focussed on the patient while the basic needs and requirements of the IC are neglected. This leads to social isolation and creates a barrier to travel. This fact offers an opportunity for local tourism operators to engage with health care providers to gain access to this niche market and aid the recovery process of the patient by allowing the IC to concentrate on the support that is expected.

State of health research in Kazakhstan: a cross-sectional study from Almaty

Background The state of health research in the countries of the Commonwealth of Independent States has been called as drastic in a recent evaluation. Several efforts have been made to break isolation of Kazakhstan from international medical research, education and practice. The aim of this study was to assess the opinion of researchers, health managers and practicing physicians about the current status of health research in Kazakhstan. Methods …

Mass Spectrometry Imaging of Sphingolipids in Preeclamptic Placentae

Mass Spectrometry Imaging of Sphingolipids in Preeclamptic Placentae

Evidence and ideology as a rationale for light-therapy in Russia: from the Soviet Union to the present day

Light therapy is still used to treat a number of common diseases in Russia. The practice is firmly anchored in history: Soviet clinical practice was divorced from the emerging field of evidence-based medicine. Medical researchers were cut off from international medical research and scientific literature, with much Soviet scientific activity based on a particular socialist ideology. In this study, the use of light therapy serves as a case study to explore tensions between international evidence-based medicine and practices developed in isolation under the Soviet Union, the legacy of which is to the detriment of many patients today. We used four different search methods to uncover scientific and grey literature, both historical and contemporary. We assessed the changing frequency of publications over time and contrasted the volume of literature on light therapy with more orthodox treatments such as statins and painkillers. Our search found an increasing number and comparatively large body of scientific publications on light therapy in the Russian language, and many publications emanating from prestigious Russian institutions. Combined with our analysis of the historical literature and our appraisal of 22 full text articles, this leads us to suggest that light therapy entered mainstream Soviet medical practice before the Stalinist period and still occupies an important position in contemporary Russian clinical practice. We propose that this outdated treatment survives in Russia in part due to the political, economic and social forces that helped to popularize it during Soviet times, and by the seeming justification offered by poorly executed studies.

RETRACTED: Attitudes of Saudi Nursing Students on AIDS and Predictors of Willingness to Provide Care for Patients in Central Saudi Arabia

1. Mostafa A. Abolfotouh[1][1] 2. Samar A. Al Saleh[1][1] 3. Aisha A. Mahfouz[1][1] 4. Sherif M. Abolfotouh[2][2] 5. Haya M. Al Fozan[3][3] 1. 1King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia 2. 2Alexandria University, Egypt 3. 3King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia 1. Mostafa A. Abolfotouh, Biobanking Section, King Abdullah International Medical Research Center (KAIMRC), Mail Code 1515, King Saud Bin-Abdulaziz University for Health Sciences (KSAU-HS), King Abdulaziz Medical City, National Guard Health Affairs, P.O.B 22490, Riyadh 11426, Saudi Arabia. Email: mabolfotouh{at}gmail.com This study aimed to assess acquired immune deficiency syndrome (AIDS)-related knowledge, attitudes, and risk perception among Saudi nursing students, and to identify predictors of their willingness to provide care for patients with AIDS. A cross-sectional study of 260 baccalaureate nursing students at King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, was done using a previously validated instrument. Students’ knowledge percentage mean score (PMS) on AIDS was 72.93 ± 10.67 reflecting an average level of knowledge. There were many misconceptions about how AIDS is transmitted, for example, use of same toilets and bathrooms and washing clothes together (24.9%), swimming (53.7%), and coughing and sneezing (49.6%). Nursing students reported an overall negative attitude toward AIDS, with a PMS of 43.48 ± 9.21. The majority of students agreed that AIDS patients should be isolated from other patients (83%), and should not share the room with other noninfected patients (81.8%), and some reported that people living with AIDS deserve what has happened to them (24.7%). After controlling for confounders, students’ poor knowledge and negative attitude were associated only with having never been given nursing education as their primary university education “Stream 2 students” ( p = .012 and p = .01, respectively). These findings have implications for development of teaching strategies and curricular approaches for nursing to address this health care issue. [1]: #aff-1 [2]: #aff-2 [3]: #aff-3

Association of HLA-DRB1*15 and HLA-DQB1* 06 with SLE in Saudis

BACKGROUND AND OBJECTIVESSystemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by humoral autoimmunity. The etiology of SLE is thought to be multifactorial including environmental, hormonal, and genetic factors. The human leukocyte antigen (HLA) has extensively been associated with the susceptibility to SLE; however, the association is heterogeneous among different ethnic groups. The aim of this study was to determine the association of HLA-A, HLA-B, HLA-DRB1, and HLA-DQB1 with SLE susceptibility in the Saudi population.DESIGN AND SETTINGSA total of 86 consecutive SLE patients attending the rheumatology clinic at King Abdulaziz Medical City, Riyadh, were recruited for this study.METHODSHLA types were determined by the polymerase chain reaction sequence-specific oligonucleotide (PCR-SSP) method in 86 patients and 356 control subjects.RESULTSThe following HLA alleles were found to be positively associated with SLE: HLA-A*29 (OR=2.70; 95% CI=1.03–7.08; P=.0035), HLA-B*51 (OR=1.81; 95% CI=1.17–2.79; P=.0066), HLA-DRB1*15 (OR=1.45; 95% CI=0.98–2.29; P=.063), and HLA-DQB1*06 (OR=1.67; 95% CI=1.19–2.36; P=.0032), whereas HLA-DRB1*16 was negatively associated with the disease (OR=0.18; 95% CI=0.02–1.3; P=.055). HLA-DRB1*15 haplotypes were significantly associated with SLE (OR=2.01, 95% CI=1.20–3.68, P=.008); this was mainly due to the HLA-DRB1* 15-DQB1*06 association.CONCLUSIONSOur data suggest an association between MHC class I and class II (HLA-A*29, HLA-B*51, HLA-DRB1*15, and HLA-DQB1*06) and susceptibility to SLE in the Saudi population. HLA-DRB1*15-DQB1*06 haplotype showed the highest risk factor for the disease that is similar to what was seen in the African American patients, suggesting shared susceptibility genetic factors among these ethnic groups.

Human Pathogens as Capstone Application of the Economics of Information to Convention on Biological Diversity: The Receptivity of Research Scientists

Economics provides powerful abstraction. To deploy that power the object of resource allocation must be correctly identified. The 1992 United Nations Convention on Biological Diversity (CBD) and the 2010 Nagoya Protocol (NP) define “genetic resources” as “material” despite being immaterial. The error has generated unresolved and contentious issues surrounding access and the fair and equitable sharing of benefits arising from utilization (ABS). A correct classification of the object as “natural information” invites “the economics of information” with radically different implications for policy: bounded openness, tracking utilization through disclosure in patents and royalties shared proportional to habitat among “countries of origin.” Human pathogens are a peculiar case of applying the same economics of information where the overarching objective is inverted: in situ eradication rather than in situ conservation. Because time translates into lives, incentives must be institutionalized for speedy entry of samples into the international medical research stream with sharing in benefits for utilization on a nuanced first-to-submit principle. As such the benefits would be greatest for just one country of origin which could then determine incentives within its scientific community. Researchers who have published work on pathogens in the first year of the NP (2011) were surveyed. The results support the application of the economics of information to ABS policy.

Field Workers at the Interface

This issue of Developing World Bioethics includes a collection of papers on intermediary staff and volunteers working at the interface between research institutions and researchers, and the communities from which research participants are recruited. ‘Field worker’ – a short hand commonly used in many research settings – refers here to those whose main role is face-to-face engagement with participants, who usually speak the participants’ first language, who are from or live in the study areas, and whose work entails moving around the study areas or health facilities. Field workers can be differentiated from medical or scientific staff for whom only part of their duties entail direct interaction with participants, and who are primarily based in the research institution or the clinic. In international research settings field workers are variously called research assistants, community interviewers, data collectors, fieldworkers, field assistants, assessors, follow up staff or defaulter tracers. Although some may hold first degrees or certificates, many are secondary school leavers without higher education opportunity; overall they are formally less qualified than clinical and research staff. Instead, field workers often have extensive informal training and experience from earlier volunteering and jobs in research centres or the NGO sector, which often require similar tasks and expertise.1 Their roles may include communicating about studies and mobilisation and follow-up of participants, conducting interviews, and carrying out relatively simple biomedical data-collection procedures such as taking temperatures and collecting finger prick blood samples.

Holistic Medicine between Religion and Science: A Secularist Construction of Spiritual Healing in Medical Literature

A particular formation can be observed in the discourse of spiritual healing and complementary and alternative medicine (CAM). Explanations of the effectiveness of spiritual healing by medical doctors and psychologists sometimes include ideological and non-scientific conclusions and concepts, which are similar to but also different from New Age science on healing. With discourse analysis discursive nodes and strategies are identified in international medical and psychological research journals at the boundary of CAM, traditional medicine, and psychosomatics from the last decade. The article develops the category of secularism to describe these propositional formations and contributes to the larger debate of postsecular societies. Postsecularism not only puts public religion but also secularisms back on the agenda. This particular secularism in the field of spiritual healing is based on transfers of knowledge and practices between subareas of a functionally differentiated society: esoteric and scientific cultural models shift into medicine, and continue into the area of health care and healing. The article demonstrates how this secularism gathers around key concepts such as emergence, quantum physics, and physicalism, and is engaged in a permanent boundary work between conventional and alternative medicine, which is governed by the notion of holistic healing.