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"Wilde, Michael"
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Breathomics for the clinician: the use of volatile organic compounds in respiratory diseases
Exhaled breath analysis has the potential to provide valuable insight on the status of various metabolic pathways taking place in the lungs locally and other vital organs, via systemic circulation. For years, volatile organic compounds (VOCs) have been proposed as feasible alternative diagnostic and prognostic biomarkers for different respiratory pathologies.We reviewed the currently published literature on the discovery of exhaled breath VOCs and their utilisation in various respiratory diseasesKey barriers in the development of clinical breath tests include the lack of unified consensus for breath collection and analysis and the complexity of understanding the relationship between the exhaled VOCs and the underlying metabolic pathways. We present a comprehensive overview, in light of published literature and our experience from coordinating a national breathomics centre, of the progress made to date and some of the key challenges in the field and ways to overcome them. We particularly focus on the relevance of breathomics to clinicians and the valuable insights it adds to diagnostics and disease monitoring.Breathomics holds great promise and our findings merit further large-scale multicentre diagnostic studies using standardised protocols to help position this novel technology at the centre of respiratory disease diagnostics.
Journal Article
The words : there's more than one way to take a life
\"Struggling writer Rory Jansen (Bradley Cooper) rockets to fame after passing off a brilliant found manuscript as his own, but experiences an acute crisis of conscience after his stint in the spotlight changes him in ways he never expected\"--Allmovie.com, January 26, 2018.
DVD
OpenMx: An Open Source Extended Structural Equation Modeling Framework
OpenMx is free, full-featured, open source, structural equation modeling (SEM) software. OpenMx runs within the
R
statistical programming environment on Windows, Mac OS–X, and Linux computers. The rationale for developing OpenMx is discussed along with the philosophy behind the user interface. The OpenMx data structures are introduced—these novel structures define the user interface framework and provide new opportunities for model specification. Two short example scripts for the specification and fitting of a confirmatory factor model are next presented. We end with an abbreviated list of modeling applications available in OpenMx 1.0 and a discussion of directions for future development.
Journal Article
An integrated analysis and comparison of serum, saliva and sebum for COVID-19 metabolomics
The majority of metabolomics studies to date have utilised blood serum or plasma, biofluids that do not necessarily address the full range of patient pathologies. Here, correlations between serum metabolites, salivary metabolites and sebum lipids are studied for the first time. 83 COVID-19 positive and negative hospitalised participants provided blood serum alongside saliva and sebum samples for analysis by liquid chromatography mass spectrometry. Widespread alterations to serum-sebum lipid relationships were observed in COVID-19 positive participants versus negative controls. There was also a marked correlation between sebum lipids and the immunostimulatory hormone dehydroepiandrosterone sulphate in the COVID-19 positive cohort. The biofluids analysed herein were also compared in terms of their ability to differentiate COVID-19 positive participants from controls; serum performed best by multivariate analysis (sensitivity and specificity of 0.97), with the dominant changes in triglyceride and bile acid levels, concordant with other studies identifying dyslipidemia as a hallmark of COVID-19 infection. Sebum performed well (sensitivity 0.92; specificity 0.84), with saliva performing worst (sensitivity 0.78; specificity 0.83). These findings show that alterations to skin lipid profiles coincide with dyslipidaemia in serum. The work also signposts the potential for integrated biofluid analyses to provide insight into the whole-body atlas of pathophysiological conditions.
Journal Article
Association of gut-related metabolites with respiratory symptoms in COVID-19: A proof-of-concept study
•Gut-related metabolites are impaired in patients with COVID-19.•Dietary markers of gut health are associated with COVID-19 symptoms (breathlessness and temperature).•A trend of worse mortality from COVID-19 is shown in patients with reduced levels of betaine.
Gut-related metabolites have been linked with respiratory disease. The crosstalk between the gut and lungs suggests that gut health may be compromised in COVID-19. The aims of the present study were to analyze a panel of gut-related metabolites (acetyl-L-carnitine, betaine, choline, L-carnitine, trimethylamine, and trimethylamine N-oxide) in patients with COVID-19, matched with healthy individuals and patients with non-COVID-19 respiratory symptoms. As results, metabolites from this panel were impaired in patients with COVID-19 and were associated with the symptoms of breathlessness and temperature, and it was possible to differentiate between COVID-19 and asthma. Preliminary results showed that lower levels of betaine appeared to be associated with poor outcomes in patients with COVID-19, suggesting betaine as a marker of gut microbiome health.
Journal Article
Effectiveness of blended learning to improve medical students’ communication skills: a randomized, controlled trial
Background
This study aimed to evaluate whether a blended learning course improves medical students’ communication skills compared to a face-to-face only lecture.
Methods
After completing a face-to-face lecture on communication skills, 2nd year medical students were gender-matched and randomized to either an intervention receiving an interactive video-based online learning module covering the content of the previous lecture and including a knowledge assessment or a control group only receiving a knowledge assessment. The primary endpoint was students’ knowledge about communication techniques assessed by a predefined score from 0 to 100. Secondary outcomes included students’ feedback and satisfaction on a scale from 0 to 5. Additionally, qualitative analysis of free-text responses to patient case vignettes was conducted.
Results
One hundred sixty-four medical students were included in the final analysis (64% female). The intervention group had significantly higher knowledge (mean, SD points) (73.6 ± 10.7 versus 56.7 ± 15.3, adjusted difference 17.02, 95%CI 12.95 to 21.1,
p
< 0.001) and reported higher satisfaction (4.3 ± 0.9 versus 3.5 ± 1.0, difference 0.78, 95%CI 0.48 to 1.07,
p
< 0.001) compared to the control group. Qualitative analysis of free-text responses also revealed improvements in patient-centered communication techniques in the intervention group.
Conclusions
Blended learning significantly enhances medical students’ communication skills and satisfaction compared to traditional lecture-based learning and may thereby contribute to the development of future knowledge and practices to improve patient-centered care.
Clinical trial number
Not applicable.
Journal Article
A Dilemma for the Russo–Williamson Thesis
The Russo–Williamson thesis maintains that establishing a causal claim in medicine normally requires establishing both a correlation and a mechanism. In this paper, I present a dilemma for defenders of this thesis: a strong version of the thesis requires denying a plausible counterexample, but as the thesis is weakened, its defenders must give up their favoured account of the explanatory role of causal claims in medicine. I appeal to some recent work in epistemology on infallibilism to propose a way out of this dilemma, where this way out requires neither denying the plausible counterexample nor giving up the favoured account. I think this shows that even apparently abstract debates in epistemology can provide resources that may help to resolve debates in the philosophy of science and medicine.
Journal Article
Mechanistic reasoning and the problem of masking
At least historically, it was common for medical practitioners to believe causal hypotheses on the basis of standalone mechanistic reasoning. However, it is now widely acknowledged that standalone mechanistic reasoning is insufficient for appropriately believing a causal hypothesis in medicine, thanks in part to the so-called problem of masking. But standalone mechanistic reasoning is not the only type of mechanistic reasoning. When exactly then is it appropriate to believe a causal hypothesis on the basis of mechanistic reasoning ? In this paper, I argue that it has proved difficult to provide a satisfying answer to this question. I also argue that this difficulty is predicted by recent work in knowledge-first epistemology. I think this shows that recent work in epistemology has important implications for practice in the philosophy of science. It is therefore worth paying closer attention in the philosophy of science to this recent work in knowledge-first epistemology.
Journal Article
A multifaceted early clinical experience course in internal medicine fosters motivation and professional growth from the perspective of first-year medical students
Background
Early clinical experience within a vertically integrated curriculum might contribute to the development of the desired competencies from the onset of studying medicine. However, most qualitative studies focused on the effects of early clinical experience on students were performed within a primary care setting in the second and third year of studies. Our aim was to explore, from the perspective of first-year medical students, the effects of an early clinical experience course in internal medicine within a tertiary hospital setting on their professional and personal development.
Methods
We used an inductive approach to conduct a conventional content analysis of 27 reflective writing reports written by first-year medical students after having completed a 60-hour early clinical experience course in the inpatient setting of a university hospital, comprising 48 h in the healthcare setting (primarily internal medicine and its subspecialties) and 12 h in team-building social events. Writing reports aimed to make students openly reflect on their course experience, elaborating on any aspect of perceived relevance.
Results
All 27 students invited to participate wrote a reflective report. We identified three themes with their respective categories of codes: (1) Professional growth, including formation of professional identity, dealing with emotions and experience with death; (2) Reinforcing motivation for further studies and work as a physician, including integration into medical studies, shaping a supporting environment and course as a highlight of the studies; and (3) Immersion into the medical field based on real-world exposure, including benefitting from early patient contact and exploration of the field of internal medicine. Throughout the reflective reports, role modelling appeared repeatedly as a driving element for the observed effects.
Conclusions
Our findings suggest that, from the perspective of first-year medical students, participation in an early clinical experience course in internal medicine within a tertiary hospital setting positively influences their initiation into professional growth, motivation for further studies and work as physician, and immersion in the medical profession. Further studies are needed to better understand the underlying success factors of such courses.
Journal Article