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Aerospace medicine: A General Outlook

Have you ever wondered what type of physician backs the American space program? Who keeps an eye on the astronauts’ health and safety while they are stcoralblueoutlet kleankanteentrinkflasche moorecains tatascarpe saldigeox relaxdaysstore senzamai blundstoneprezzi donkeyluckycat geoxoutlet 24bottlesclima donkeyluckycat cainsmooredonna saldibenetton uspoloassnscarpeationed in space and is on standby for when they go and return? Who, in addition to engineers, pilots, and other top experts, contributes to the planning of the planned Lunar and Mars missions? Aerospace medicine is this area of study.

Clinical care, research, and operational support for the health, safety, and performance of the crew and passengers of aircraft and spacecraft, as well as the support staff who help operate such vehicles, are the main areas of focus in aerospace medicine. This group frequently works and lives in physically and psychologically demanding circumstances in distant, severe, or enclosed places. Practitioners aim for the best human-machine compatibility in work environments that are full of engineering safeguards against environmental risks.

A brief history:

• • 1783: Jean-Francois Pilâtre de Rozier and Marquis d’Arlandes make the first manned free balloon flight.
  • 1875: French scientists Gaston Tissandier Joseph Croce-Spinelli and Théodore Sivel reach an altitude of 28,000 ft in their balloon using oxygen in sheepskin bags provided by physiologist Paul Bert.
  • 1911: Lt. Washington Irving Chambers meets with aviation pioneer Glenn Curtiss to discuss the possibility of aircraft aboard Navy ships. Dr. Ralph P. Greene was the first U.S. medical officer ordered to fly duty. Greene later serves as the 2nd president of the Aerospace Medical Association.
  • Army Flight Surgeon Col. Isaac H. Jones (1881–1956) published his book Equilibrium and Vertigo.
  • 1922: Five U.S. Navy lieutenants graduate from the School of Aviation Medicine as flight surgeons.
  • 1925: The Air Corps Physiologic Research Laboratory at Wright Field, Dayton, OH, investigates hypobaric states, hypoxia, and the effects of centrifugal force on pilots.
  • Lieutenant Bertram Groesbeck Jr. (1894–1968) is the first medical officer in the U.S. Navy to be given wings as a Naval Aviator. He writes an essay about “blind flying” (instrument flight) in 1930 and publishes it in the Journal of Aviation Medicine.
  • In 1939 the U.S. Navy establishes its School of Aviation Medicine at Pensacola; FL. On November 30, five naval flight surgeons received their diplomas.
  • Lt. Col. (Dr.) William R. Lovelace makes the first aircraft flight using pressure breathing in 1942.
  • 1964: The Coriolis Acceleration Platform and Vestibular Unit are dedicated at the U.S. Navy School of Aviation Medicine.
  • 1995: Developed by Navy Flight Surgeon Capt. Angus Rupert, the Tactile Situation Awareness System (TSAS) shows promise in mitigating spatial disorientation in flight.

Effects of Space on the Body

The short- and long-term impacts of space conditions on the human body have been researched by space agencies. When they suffer from ailments like altitude sickness or the sensation of their ears “popping,” passengers provide the general public a brief glimpse into the impacts of flight. As soon as people leave the safe bubble of our atmosphere, several risks arise, making life in space considerably more challenging. According to NASA, there are five types of stress associated with space travel. These can be summarized with the acronym RIDGE:

• Radiation from space: Astronauts are exposed to 10 times as much radiation aboard the International Space Station as they are on Earth. This poses a higher chance of developing cancer and might harm the central nervous system, which could lead to issues with cognition, movement, and behavioral abnormalities. Radiation illness and degenerative tissue disorders, including cataracts and heart problems, can also be brought on by space travel.
• Isolation and separation: Living on the International Space Station (ISS) or a spacecraft has psychological effects in addition to physical ones, which are equally significant. Long-term confinement in a limited area can lead to behavioral problems in the group as well as a drop in mood and morale, difficulties sleeping, and boredom.
• Distance from Earth: It’s not precisely possible for an astronaut to dial 911 and request an ambulance to take them to the hospital if they become ill or hurt. They pose a health concern just by being so distant from Earth. This is a problem on the ISS, but it will be crucial for upcoming Moon and Mars missions.
• Gravity fields: The absence of gravity has an impact on balance, locomotion, head-eye and hand-eye coordination, and spatial orientation. Additionally, without gravity, your bones lose minerals, resulting in a monthly density loss of nearly 1%. To combat this, astronauts must spend 2.5 hours every day working out in space.
• Enclosed and Hostile conditions: Living a sheltered life is unhealthy. Your immune system is weakened, germs may spread readily, and stress hormones are increased.

Modern trends in aerospace medicine:

Aerospace medicine is regarded as a specialist area of medicine that is concerned with the upkeep of the health and effectiveness of the aircrew in the environment of space and flight. Additionally boosting the global aerospace medicine market’s revenue growth is the pharmaceutical industry’s growing interest in aerospace medicine. Doctors in aerospace medicine work for commercial airlines, the military, space agencies, regulatory organizations, and independent clinics that specialize in medical flight certification.

When people are subjected to the challenges of aircraft flight, such as high temperatures, low oxygen levels, atmospheric pressure, noise, radiation, and powerful acceleration and deceleration forces, aerospace medicine supports their safety and effectiveness. Aircraft medicine, often known as aviation medicine, plays a significant role in ensuring that the aerospace environment is safe and healthy for every pilot. But aerospace medicine is a brand-new, cutting-edge area of medicine that opens up a ton of business prospects for drug manufacturers and other suppliers.

The Aerospace Medical Association (AsMA) conducts several case studies and investigations on aviation, space, and environmental medicine on modern trends. The man-machine interaction has been significantly altered by evolving technology and unmanned aerial vehicles, leading to a shift in the practice of aerospace medicine. The worldwide aerospace medicine market is anticipated to increase as a result of the expanding airline sector and military aviation forces. Aerospace doctors are knowledgeable about the physiological effects of exposure to the space environment and appropriate medical care to guarantee everyone’s safety in the sky. The expansion of the aerospace medicine industry may be hampered by the high quantity of harmful chemicals found during the flight.

Flight surgeons are medical professionals with specialized training in aircraft medicine. There are medical professionals in aerospace medicine throughout the world. The aforementioned problems are not sufficiently covered in primary care or surgical specializations to treat the medical needs of military and civilian aviators and space travelers. Aerospace medicine is growing more and more appealing with the rise of passengers of all ages. Soon, it is anticipated that the “Aerospace Medicine Market” would rise astonishingly. AsMA is committed to improving the performance, safety, and health of everyone who travels or works in the air, underwater, or in space.

Visit: https://www.nasa.gov/sites/default/files/atoms/files/space_portal_graham_mackintosh.pdf

Future of Aerospace medicine

The previous year has demonstrated that medicine and medical treatments aren’t just limited to doctor’s offices. Telemedicine and AI technologies helped to guarantee that individuals received the care they required even while a pandemic swept the planet. Future medicine might be more intelligent. From the comfort of our homes, we could examine our blood for infections. We could find a tap and transform tap water into sterile IV fluid instead of rushing a dehydrated patient to the hospital. Medical imaging devices might scan our bodies whenever and wherever we are and transmit automatic readouts to human and artificial intelligence (AI) medical professionals anywhere in the world (or worlds). That is the hope for the future of Earth. However, it is already underway in space, hundreds of miles above the surface, where aerospace medicine is creating the foundation for tomorrow’s healthcare.

Awareness among medical students:

Specific training concentrating on the medical fields like space medicine receives less attention. Medical students’ education can help them become candidates or educators in space medicine, and this education may be required for the next generations. In the current study, we sought to gauge the degree of knowledge in this area among Turkish medical school students. Resources and Method: Our research is intended to be cross-sectional and includes medical students. Participants in various grades who consented to complete the space medicine-focused awareness questionnaire were included. It was shown that 42.1% of the students lacked knowledge about space medicine. Similarly, 56.3% of the students who took part in the survey were not aware that this specialty was within the umbrella of medicine. The majority of medical school students were unaware that there was a discipline of aerospace medicine, and only a small percentage of them had any understanding of space medicine.(Emre, 2022)

Aerospace medicine and Sri Lanka: A Pioneer.

Dr. (Mrs.) Anoma Jayasinghe, Group Medical Officer of Sri Lankan Airlines, has become the first Sri Lankan professional in aviation medicine to be selected as a Member of the International Academy of Aviation and Space Medicine (IAASM), in recognition of her contribution to this field in Sri Lanka for over a decade. She is a full member of the Australian Society of Aerospace Medicine, a Member of the Aero Space Medical Association USA (AsMA), and a Designated Aviation Medical Examiner of the Civil Aviation Safety Authority Australia (CASA).

Dr. Jayasinghe would be an Academician of IAASM, Academicians are leaders in aerospace medicine and related sciences who work as a select group and provide a platform for academics and medical professionals to present original scientific papers related to aviation and space medicine.

Founded in 1955, IAASM (www.iaasm.org) has a limited membership of approximately 240 medical professionals from around the world, from airlines, civil aviation regulatory authorities, and organizations involved in aviation and space travel, the national carrier said in a media release. She pursued post-graduate training in Aviation Medicine and obtained the Australian Certificate of Civil Aviation Medicine from Monash University; Aviation Medicine Course from Singapore Aviation Academy; and a Diploma in Occupational Health and Safety from the University of Colombo. Aviation and Space Medicine are the fields in medicine that are concerned with the maintenance of health, safety, and performance of those involved in aviation or space activity.

Reference list:

AsMA | Aerospace Medical Association (no date) www.asma.org. Available at: https://www.asma.org/about-asma/careers/aerospace-medicine .

Dr. Anoma Jayasinghe, first Sri Lankan member of prestigious IAASM (2017) The Sunday Times Sri Lanka. Available at: https://www.sundaytimes.lk/170312/business-times/dr-anoma-jayasinghe-first-sri-lankan-member-of-prestigious-iaasm-232034.html  (Accessed: 5 July 2022).

Emre, S. (2022) What Do Medical Students Know About Space Medicine?

Gifford, S. (2021) Future Aerospace Medicine: Coming to a Planet Near You, Now. Powered by Northrop Grumman. Available at: https://now.northropgrumman.com/future-aerospace-medicine-coming-to-a-planet-near-you/ .

McSweeney, K. (2021) The Next Frontier: Aerospace Medicine, Now. Powered by Northrop Grumman. Available at: https://now.northropgrumman.com/the-next-frontier-aerospace-medicine/ .

Singh, A. (2022) Aerospace Medicine Market 2022 Industry Trends, Sales, Supply, Demand, Analysis & Forecast to 2031, EIN News. Available at: https://www.einnews.com/pr_news/566470136/aerospace-medicine-market-2022-industry-trends-sales-supply-demand-analysis-forecast-to-2031  (Accessed: 5 July 2022).

Stratton, E. (2019) Aerospace Medicine? www.emra.org. Available at: https://www.emra.org/emresident/article/aerospace-medicine/ .

Tarver, W.J. (2007) An Introduction to the History of Aerospace Medicine, ntrs.nasa.gov. Available at: https://ntrs.nasa.gov/citations/20070029992  (Accessed: 5 July 2022).

Image Credits:

1. An Introduction to the History of Aerospace Medicine – NASA Technical Reports Server (NTRS)
2. https://www.nasa.gov/hrp/bodyinspace
3. https://www.nasa.gov/sites/default/files/atoms/files/space_portal_graham_mackintosh.pdf

In 1945, something remarkable happened. A 67 year old woman opened her eyes and declared “I’m going to divorce my husband”. Which she did. But more importantly, she had also marked a milestone in medical history. The woman’s name was Sofia Maria Schafstadt and she had just regained consciousness from a uraemic coma after 11 hours of treatment on the world’s first dialysis machine. Kidney diseases may have been almost as old as human history itself. Descriptions of kidney disease can be traced to as far back in time as early Rome; although their knowledge of treatment was considerably limited and included the use of hot baths, sweating therapies and even bloodletting.

The actual concept of a dialyzer was first conceived in the 1830s by Thomas Graham, a Scottish chemist. In his work Graham explored the possibility of utilizing certain methods used in chemical laboratories for the purpose of separating solutes from their respective solutions, to be used for filtering uraemic substances from the blood of patients with kidney disease. He was referring to the principles of osmosis and the function of semipermeable membranes.

Despite being radically ahead of his time, Graham’s work remained largely confined to being an idea; a mere concept. A practical method of dialysis would not come into effect until 1913, when Leonard Rowntree and John Abel of John Hopkins Hospital came up with a working dialysis system, which they successfully tested on animals.

A German doctor named Georg Haas, performed the first dialysis treatments involving humans. Sadly, none of his subjects survived.

It wasn’t until 1943, that the first medically useful dialyzer would be constructed, by a Dutch doctor named Willem Kolff. Kolff had already begun research on a possible new method to create an artificial kidney while serving as a doctor in the wards of University of Groningen Hospital, Netherlands. Around the same time, the Nazis invaded the Netherlands and Kolff was sent to work in a remote Dutch hospital.

There, Kolff resumed his research and ultimately came up with a functioning dialysis machine, albeit a rather crude one constructed from a washing machine, orange juice cans, sausage skins and other forms of “junk”. Emboldened by his newfound success, he treated 16 patients with acute kidney failure, using his machine over the course of 2 years. All 16 patients died. Then in 1945, Kolff treated his 17^th patient, none other than Maria Sofia who recovered from her uraemic coma. She lived for 7 more years before dying of unrelated causes. As for Kolff himself, he never bothered to patent his invention. Instead, he actually distributed copies to hospitals across the world. Some of his machines made their way to Peter Brent Brigham Hospital in Boston, where they underwent a significant technical improvement; giving rise to the Kolff-Brigham artificial kidneys, which first saw practical use during the Korean War.

In 1947, Swedish scientist Nils Alwall published a paper on a new design for a modified dialyzer which would be able to perform the required combination of dialysis and ultrafiltration better than Kolff’s original machine.

Over time, technology improved, modifications were made, and newer more sophisticated versions of dialysis machines were produced. And just as the technology of dialyzers continues to develop, likewise the scientific principles regarding the transport of particles across membranes saw considerable improvements as well, and these in turn were applied specifically for dialysis purposes.

No doubt, we have come quite far since, Kolff’s washing machine and sausage skins. And with each passing day of new discoveries being made, who knows what we will have in store for the future.

Written by Dimantha Bandara

References

1.  History of Kidney Disease Treatment, https:// www.sgkpa.org.uk/history-of-the-kidney-disease-treatment

2. The history of dialysis, https://www.freseniusmedicalcare.com/en/media/insights/company-features/the-history-of-dialysis

3. The Oxford Handbook of clinical medicine, 10^th edition

Marie Curie can be considered as a remarkable individual in history of research, whose discoveries broke new grounds in physics and chemistry. Furthermmoorecains coralblueoutlet ovyeshop coralblueoutlet loevenichhutkaufen saldibenetton guardianiscarpe donkeywinkekatze fracominaoutlet akuscarpe ynotsaldi blundstoneprezzi senzamai legioiedigea giga-sportore, She opened a new chapter for women in science: she was, the first woman to receive a doctor of science degree in France, the first woman to win Nobel Prize and the first woman to lecture at the Sorbonne……….
Maria Salomea Sklodowska was born in Poland, in 1867 as the youngest of the family of five children. Maria came from a family that valued comprehensive education for both the girls and boys. Her family had to face some tragic incidents initially; Maria’s oldest sister died of typhus when Maria was 11 and her mother, died soon afterwards, of tuberculosis. However, the family was determined to give the best education possible to children. Maria, like her siblings, was rigorously educated in several languages, mathematics and science. Public mention of some of the lessons she learned could have resulted in the arrest and exile of her teachers and her family. Maria has been a brilliant child and graduated at the age of 15, receiving many academic awards.
There was no chance of further education for Maria, as universities in Poland didn’t enrol women. Her family did not have the means to send the three daughters to study in Paris or St. Petersburg, where some universities were open to women. Therefore, Maria and sisters began to work as private tutors, while getting enrolled in an illegal university called the Flying University which provided advanced education for female students secretly.
Later Maria’s sister, Bronia left for Paris, to study medicine. Maria used her wages to support Bronia while she studied. During this time, Maria got an opportunity to perform laboratory research secretly with her cousin where she discovered her talent for experimental laboratory research. In the meantime, Bronia graduated from medical school, opened a practice in Paris and supported Maria to continue her studies at the Sorbonne, Paris.
Marie met Pierre in 1884. Introduced by mutual friends, their scientific relationship which began with Pierre sending Marie reprints of his scientific papers, progressed to more personal letters and visits. Marie began her research on the magnetic properties of steel in a converted storage room in Pierre’s laboratory space. In 1895, Pierre and Marie were married in Paris. Pierre and Marie continued to research as a team.
In 1895, after Roentgen discovered X-rays, Henri Becquerel began to explore the idea that phosphorescent substances also produced X-rays. Even though he tried many phosphorescent materials, only uranium salts produced these rays, and it did not matter whether the uranium was in a phosphorescent chemical form or whether it was exposed to light. Becquerel then seems to have lost interest, but this phenomenon stirred the Curies’ interest, which was the subject for her doctoral thesis. Its noteworthy that at this time, no woman in Europe had yet completed a doctorate.
In 1898, a report entitled “Rays emitted by uranium and thorium compounds” was presented by Marie and she introduced the concept of spontaneous radiation. Also she presented her views on an unknown element that could be discovered by showing that its radioactivity was different from that of any known element.
Marie and Pierre set out to isolate this new element in pitchblende. After years of hardwork, Radium and Polonium were isolated. To quote Marie, “Our precious products, for which we had no shelter, were arranged on tables and boards; from all sides we could see their slightly luminous silhouettes, and these gleamings, which seemed suspended in the darkness, stirred us with ever new emotion and enchantment”
In 1903, Marie received the degree of Docteur des Sciences Physiques with the mention “tres honorable.” In November 1903, the Royal Society of London presented them with the Davy Medal. In 1903, she won Nobel Prize in Physics for her work on spontaneous radiation, becoming the first woman to receive a Nobel prize.
After Pierre’s death in 1906, Marie assumed Pierre’s teaching responsibilities and became the first woman to lecture at the Sorbonne. The second Nobel prize was awarded, in 1911, in Chemistry, recognizing her work on Polonium and Radium that she had performed after receiving the 1903 Nobel prize.
Marie was appalled at the lack of modern medical care available to the wounded soldiers on the front lines during the era of war. To address this problem, she devised and built “radiology cars,” to carry diagnostic radiology to the battlefront. Marie also established and oversaw programs to train physicians and technicians to operate these units. Her name also became associated with the medical uses of radiation through this route, as well as through the growing use of radium in the treatment of cancer.
Marie Curie continued her work as a scientist and an ambassador for science. Her health continued to decline, probably induced by radiation. With her typical desire for privacy, she hid her problems, and many (including her blindness) were unknown to anyone, until after her death. Marie Curie died on 4th July, 1934, at the age of 66. The cause of her death was given at the time as aplastic anemia, believed to have been contracted from her long term exposure to radiation.
Marie Curie is still one of the world’s most popular scientists, remembered not only for the excellence of her science, but also for her passion for science and her role in changing education for women. Each step of her journey in science is remarkable. Her legacy will live on forever in the hearts of people.

Reference

1. Rockwell S. The life and legacy of Marie Curie. Yale J Biol Med. 2003;76(4-6):167-180.

What is H-index?   

The H-index reveals two things,

1. The researcher’s PRODUCTIVITY (No of publications a researcher has produced)
2. The IMPACT of that researcher’s publications (how many citations the researcher’s publications have received)

How H-index is calculated?

If a researcher has a h-index of n, that menegozigeox tatascarpe lecosonnenschirm coralbluescarpe saldigeox moorecains saldigeox saldibenetton lecosonnenschirm borsegabsoutlet gigasport-online chilloutshut 24bottlesclima lamilanesaborse marellaoutletns author has n publications that each have at least n citations, where n is as great as it can be. For instance, an h-index of 15 means that the scientist has published at least 15 papers that have each been cited at least 15 times each. [1]

What are the advantages of H-index?          

• It combines measures of quantity (publications) and impact (citations). [2]
• It performs better in evaluating the scientific output of a researcher than other commonly used single-number criteria (impact factor, total number of documents, total number of citations, citation per paper rate and number of highly cited papers). [2]
• It plays an important role when making decisions about promotions, fund allocation and awarding prizes as a measurement of scientific output of a researcher. [2]
• H-index is easy to understand and can be easily obtained by anyone with access to the Thomson ISI Web of Science. [2]

How do we find a H-index of a researcher?

Below are instructions to obtain h-index from Web of Science, Scopus, and Google Scholar.

• Web of Science
• Enter the name of the author/researcher in the top search box (e.g. Smith JT). 
• Select Author from the drop-down menu on the right.
• To ensure accuracy for popular names, add an additional search box and enter “Univ Illinois” and then select “Address” from the field drop down menu on the right.
• Click on Search
• Click on Citation Report on the right hand corner of the results page.  The H-index is on the right of the screen.

• Scopus
• Click on the Author search tab.
• Enter the name of the author in the search box.  If you are using initials for the first and/or middle name, be sure to enter periods after the initials (e.g. Smith J.T.).
• If it is a popular name, you may enter University of Illinois in the affiliation field, to ensure accuracy. 
• Click search.
• If more than one profile appears, select the interested profile. Under the Research section, you will see the h-index listed.
• If the researcher has worked at more than one place, your name may appear twice with 2 separate h-index ratings.  Select the check box next to each relevant profile, and click show documents.

• Google Scholar
• Using your google (gmail) account, create a profile of all your articles captured in Google Scholar.
• Follow the prompt on the screen to set up your profile. Once completed, this will show all the instances articles are cited by other documents in Google Scholar and your h-index will also appear. 
• It’s your choice whether you make your profile public or private but if you make it public, you can link to it your own webpages.

References

1https://mdanderson.libanswers.com/faq/26221#:~:text=The%20h%2Dindex%20is%20calculated,cited%20at%20least%2017%20times.

2- https://doi.org/10.1016/j.joi.2007.02.001

3- https://researchguides.uic.edu/c.php?g=252299&p=1683205

When looking through the evolution of clinical research over the decades, Dr. James Lind’s contribution has always borsegabsoutlet kleankanteenkinder relaxdaysstore capsvondutch tatacalzature giga-sport 24hbottle borsalamilanesa guardianialberto donkeyluckycat loevenichmutze guardianialberto marellaabiti fracominasaldi saldigeoxeen considered as a major turning point. He has marked a significant milestone by conducting the world’s first ever documented controlled clinical trial on scurvy patients.^[1]

Scurvy is a state of dietary deficiency of vitamin C (ascorbic acid). The human body cannot produce it’s own vitamin C and the body’s pool of vitamin C can be depleted in 1-3 months in the absence of a dietary source.^[2]Even though it is rarer now, scurvy is probably the nutritional deficiency disease that has caused the most suffering in recorded history.

Since the late 16^th century, when European countries embarked on long intercontinental sea voyages, scurvy has been a nightmare disease for the sailors. Sailors were especially affected because they were away on sea for months and had no fresh food. They presented with lack of enthusiasm, weakness, easy bruising, tiny or large skin haemorrhage, bleeding gums, swollen legs and ultimately died if untreated.^[3]

As this went on for decades, even though no one knew what was causing the disease, with experience, lay people knew that this deadly disease could be cured and prevented by oranges and lemons. However, most Physicians ignored this lay therapy in favour of ancient theories and polypharmacy.^[4]

While working as a surgeon on a ship,appalled by the high mortality of this disease, James Lind planned a trial in search of the most promising cure.On 20^th of May 1747, he selected 12 patients with scurvy on board. The patients selected in general were of similar disease state as much as possible, with putrid gums, lack of energy, weakness of the knees & so on.^[3] They were separated from others and kept in one place& were given one common diet. This depicts James Lind’s understanding of the need to safeguard against selection bias and shows how he has tried to maintain clinical conditions, environment and basic diet constant.

Six treatment strategies; a quart of cider a day,25 drops of elixir of vitriol (a mixture of sulphuric and alcohol) 3 times a day, two spoonfuls of vinegar 3 times a day, a course of sea water, 2 oranges and one lemon a day,an electuary (medicinal substance) recommended by a hospital surgeon were considered for the trial. Two of the patients were assigned to each treatment strategy. The most sudden and visible positive effects were seen with orange and lemon & one person was fit for duty at the end of 6 days of treatment. ^[3]

This is considered the first documented controlled clinical trial of the modern era. James Lind has written his experiences in “a treatise of the scurvy”,published in Edinburgh in 1753 which also contains a systematic review of previous literature on scurvy.^[3]Throughout the centuries, clinical trials have come a long way while facing many challenges; scientific, ethical and regulatory. By discovering new treatments as well as new ways to detect, diagnose and prevent diseases, clinical trials have provided and will continue to provide the scientific basis for evidence based medicine.

REFERENCES

1. Bhatt A. Evolution of clinical research: A history before and beyond James Lind. PerspectClin Res. 2010;1:6–10.
2. Scurvy: Practice Essentials, Pathophysiology, Etiology [Internet]. Emedicine.medscape.com. 2021 [cited 5 July 2021]. Available from: https://emedicine.medscape.com/article/125350-overview
3. Milne I. Who was James Lind, and what exactly did he achieve. J R Soc Med. 2012;105(12):503-508. doi:10.1258/jrsm.2012.12k090
4. Baron J. Evolution of clinical research: A history before and beyond James Lind. Perspectives in Clinical Research. 2012;3(4):149.

Mainly, IF is a ratio intended for a given journal in a given year. This ratio is calculated by dividing  the total number of citations received throughout the year  for the publications in the given journal  that were published in the two preceding years, by  the  totalchilloutshut harmonte-blaine donkeyluckycat 24bottlesclima benettonoutlet donkeyluckycat kleankanteenkinder senzamai harmonte-blaine lamilanesaborse fracominaoutlet scarpeovye kleankanteenkinder chilloutshut lecopavillon number of “citable items” or publications published in that journal during the two preceding years. It can be written as an equation as follows.

Impact factor (for a given year) = Total number of citations received within the given year for the publications that were published in the two preceding years/Total number of citable items published in two preceding years

For example, if a journal has an IF of 3 in 2008, then its papers published in 2006 and 2007 received three citations each on average in 2008. The 2008 IFs are actually published in 2009; they cannot be calculated until all of the 2008 publications have been processed by the indexing agency.

Therefore, IF denotes the yearly average number of citations of articles published in the last two years in a given journal. Impact factor can be calculated after completing the minimum of 3 years of publication. Because of this reason journal IF cannot be calculated for new journals. The journal with the highest IF is the one that published the most cited articles over a 2-year period.  The IF applies only to journals, not to individual articles or individual scientists like the “H-index.”

IF is commonly used to evaluate the relative importance of a journal within its field. Journals with higher IFs are believed to be more important than those with lower ones. Hence impact factor can be used to compare different journals within a certain field.

Following are impact factors of  some of the popular journals in the year 2019.

• Lancet 60.392
• Nature 42.778
• British Medical Journal 30.223
• JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 45.540

As we all know, one cannot just conduct a research study out of the blue without a proper knowledge of the topic & of the previous studies conducted inchilloutshut harmonte-blaine donkeyluckycat 24bottlesclima benettonoutlet donkeyluckycat kleankanteenkinder senzamai harmonte-blaine lamilanesaborse fracominaoutlet scarpeovye kleankanteenkinder chilloutshut lecopavillon that area. This is where the term ‘literature survey’ comes into play. It is the process of searching & collecting relevant information on the topic of interest. Even if our purpose is something as informal as just reading up on a topic, using a proper method will help us to obtain accurate & relevant information.

Let us talk about a research study. After the ‘search’, a literature review which is basically a critical analysis of that information, will be written.  This is a key part of the whole process as it allows us to get the relevant information about the topic & to ensure that our study is not a mere repetition. It also helps us to highlight the role of our study in adding to the existing knowledge in the particular area.

However, this ‘Search’ is not as easy as it sounds, as evident by there being an article on this topic.

What are some of the problems that we may face?

Well first of all, we might have a difficulty in finding out a lot of information. Even if we find the information, it is usually very difficult to separate right from wrong & to identify the relevant information from a sea of irrelevant information. The information gained through this manner may even be deficient in certain areas. Therefore, in order to avoid these problems, a proper Search Strategy is required.

In order to implement our strategy, we must first identify the sources of information.

 Sources can either be printed, like books, magazines, encyclopedias, and journals or electronic, like ebooks, ejournals, electronic databases etc. After identifying the source we must use the proper strategy.

A search strategy has several steps. Basically speaking, one must

• Clarify the topic that we are searching for. Eg – Is Calcium supplementation effective in managing post menopausal osteoporosis in women?
• Breaking up this topic into key concepts. Eg – Calcium supplementation, post menopausal osteoporosis etc
• Translating the topic into subject terms & synonyms

Why? – Different researchers may have used different words to describe the same thing & therefore some important articles may be missed.

One can search using many synonyms, but an easier method where a standard vocabulary (MeSH terms) is used will be explained later in this article.

• Proper use of words like AND, OR, NOT (Boolean operators)etc

• Wildcard – Using # to symbolize different spellings (British / American)

Eg – colo#r would yield articles for colour & color

• Truncation – chop off (using * or!)

Eg – Educat* or Educat!  would yield articles for education, educating, educated etc

• Refining the search. Eg – Checking spellings, reassessing the question etc

In this age of technology, the most commonly used sources are online ones.

What are the most used online sources?

Pubmed

It is the most widely used website in the search for medical research. With the above steps in mind, one can either perform a simple search or a more advanced search. The advanced search option allows us to select

• A particular field (to simplify the search) – eg- Author, Date, Journal etc. or even ‘all fields’
• Enter search terms (osteoporosis etc) &
• Combine with other terms using AND / OR / NOT etc

It also allows us to use the MeSH system (under fields) to make our search easier.

What is MeSH?

Medical Subject Headings (MeSH) consist of a standard vocabulary that is internationally accepted & used to give uniformity to the cataloging of biomedical literature. It was built by the US National library of medicine (NLM). In short, it helps to bypass the issue which arises due to synonyms & is used to describe books & audiovisuals in the NLM & other medical library collections.

Another popular website (search engine) which can be used is Google scholar.

Depending on the nature of the topic, various other websites ranging from the official WHO website, to local websites such as the websites of the Ministry of Health, the Epidemiology Unit, the Department of Census & statistics & Sri Lanka Journals Online can be used in our literature search.  There are also other reliable sites such as JSTOR / Taylor Francis Online & the sites of acclaimed universities in the world. However, one must always evaluate the information obtained, as some of the information provided by unreliable sites may be false.

How exactly do we evaluate the information?

We must assess whether the information is up – to – date, relevant to the topic, accurate, who the author is & what the purpose of the author (to promote something etc) is.

Tip – Check the domains. Websites with ‘com’ are less reliable while those with ‘edu’ or ‘gov’ are more reliable.

Other online sources  – ejournals, ebooks, subject gateways, or even the e resources of the library of the university that we study in.

A subject gateway is a collection of websites on a particular subject. Unlike search engines, they contain only web resources that have been evaluated by specialists.  (eg – HINARI)

Even though the trend is to pursue online sources, one must not forget the printed sources like books, magazines, encyclopedias, and journals with research articles & also reviews. A bibliography is something which we can use for this purpose. It includes all the relevant resources pertaining to a particular topic & can come in handy once a topic has been identified.

No matter what our topic is, the literature review will be much easier if we go about it in a methodical way. One must always keep in mind that the literature review is the foundation upon which our entire research is built upon. If the foundations are laid correctly, the rest will be a piece of cake.

What comes to your mind when anyone talks of ethics? Maybe, choosing between good and bad or right from wrong, that would be the basic idea and bulecopavillon gioie-di-gea 24bottles borsegabsoutlet tatacalzature guardianiscarpe 24bottles kleankanteenkinder gioie-di-gea ovyeshop tatascarpe gioie-di-gea mandarinaducksaldi von-dutch gigasportoutfitdamenilding on that, ethics is a study of moral principles and refers to a code of morals followed by an individual or a group. They prescribe what we ought to do and affects our behaviour and decision making. Ethics is a vast area of study with many fields, so let’s focus on how we apply it in medicine. 

Medical ethics refers to the moral values that govern medicine. It applies to clinical medicine and associated scientific research. One of the oldest written documents on ethics is the Hippocrates oath, which is still used today albeit somewhat modernised, to initiate doctors in their practice. In the doctor-patient relationship, the conduct of the doctor should follow the four pillars of medical ethics. They are autonomy, beneficence, non-maleficence and justice.

Let’s take an example, a 25 year old female who is a Jehovahs witness sustained serious injuries in a car crash, but she has refused blood transfusions despite losing a lot of blood.

Autonomy refers to the right of a patient to make decisions for themselves. It involves the principle of informed consent as well. In the above case the doctor would have explained the risks of not undergoing a transfusion but would have to respect the patients decision. (Jehovahs witnesses refuse blood products as it is against their beliefs) In such cases there is conflict between autonomy and doing what’s best for the patient. The latter is also called beneficence. Non-maleficence refers to doing no harm and justice is  fair distribution of resources.

Research is done, simply to find things out and it commonly involves humans, specially with regards to medicine. Therefore ethics are needed to protect participants and to make sure the study is of value to the society. Research should be conducted so that the knowledge produced can be used and shared widely and the participants should be treated with respect and dignity.

The principles of ethics in research are not only limited to the basic four principles but includes what is mentioned above like social value and respect for participants, also scientific validity, fair subject selection, favourable risk benefit ratio, independent review and informed consent. Not abiding to these principles has led to several tragedies and tarnished reputations of individuals and institutions.

Infamous examples of research conducted with no regards to human rights have been documented throughout history.

In 1932, a group of 400 black men with syphilis were recruited in a study to track the progression of the disease, which had no cure at the time. However in 1942, penicillin became the treatment of choice for syphilis but it was not offered to the participants. Due to the publishing of the study in a newspaper the ethical aspects were brought to attention only in 1972, after which the study was stopped. As a result many died and their wives and children were infected.

In a similar timeline, German scientists conducted experiments of a horrendous nature on concentration camp prisoners which ended with the scientists being penalised in the Nuremberg trials. As a result the Nuremberg code was compiled, which was the first international code of ethics for research on human subjects. Later on the World Medical Association published the Declaration of Helsinki which was a result of significant effort of the medical community to regulate research.

So in a way people have learnt from the mistakes of their peers but the question remains “Is it necessary to risk the lives of some for the benefit of many?” Somewhat of a trolley problem, isn’t it?  This was a thought experiment on ethics and psychology and is as follows, say a runaway trolley is heading  towards five people who are tied to the tracks. If it continues on its path they would be killed but if you pull a lever the trolley would deviate to a different track but would kill 1 person. What would you do?

Let’s look at this problem from a modern angle. The covid pandemic has caused millions of deaths and millions more infected. From the beginning it was apparent that a vaccine was necessary but this process usually took several years to complete. However due to streamlining resources and collaborations this process was accelerated to produce a vaccine by the end of 2020.

A crucial step in vaccine development is the challenge test which is usually done in the preclinical study in an animal model but for covid 19 and some other diseases this is not available. Thus Controlled Human Infection(CHI) was needed. It sounds like unsafe experimentation but people volunteered due to the importance and necessity of a vaccine.

This raises many ethical issues and no matter the urgency of the situation, research ethics should be maintained. These moral dilemmas are difficult to navigate and promote thinking rather than provide an exact solution.

To make sure that researches are designed and conducted ethically, governing bodies called ethic review boards have been established in order to safeguard the rights and wellbeing of participants. Additionally when a study is being published, the researcher should act with integrity. They should avoid fabricating, falsifying data and plagiarism. This tend to happen when people are desperate, say they’re running short on a deadline or maybe just to reap the benefits without actual hard work. Hence mutual respect for other researchers ensures the creation of a conducive environment for the advancement of science and research.

If one is thinking of becoming proficient in research then learning its ethical aspect is integral. An obligation of the already skilled researcher is to teach the future generations on the importance of ethics and the duty of the student is to learn and apply the concepts properly so as to avoid repeating past mistakes.

References

1. What is ethics in research? https://www.niehs.nih.gov/research/resources/bioethics/whatis/index.cfm

2. Vaccine experiments – scandal-hepatitis-experiments-hideous-truths-of-testing-vaccines-on-humans/?sh=e17bc8e279c8

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675299/

The human body has the natural ability to heal itself in many ways. A cut to the skin, broken bones mend and a living-donor’s liver regenerates in a few weeks. What if scientists can make use of the body’s innate ability to heal itself, to replace daysrelax gigasport-online von-dutch fracominaabiti von-dutch lamilanesaborse 24h-bottle blundstoneoutlet kleankanteenkinder 24bottlesclima 24bottlesclima coralbluescarpe tatacalzature ynotoutlet tatacalzaturedamaged organs or tissues? Well that’s what regenerative medicine is all about….

According to Dr. Heather Greenwood et al., “regenerative medicine is an emerging interdisciplinary field of research and clinical applications focused on the repair, replacement or regeneration of cells, tissues or organs to restore impaired function resulting from any cause, including congenital defects, diseases, trauma and aging”. It’s an emerging branch of medicine which shows a promising future. The currently used treatment option of transplantation to replace damaged or diseased organs and tissues has many drawbacks. There is a limited pool of donors and the recipients have to be on lifelong immunosuppression which makes them susceptible to many opportunistic infections. And to mention the fact that there is a huge risk of graft rejection which will render the entire procedure moot as well as the highly feared host vs. graft reactions. Taking all of these matters into consideration, regenerative medicine seems like a more appropriate and convenient option at present.

Several principles are being used in this field:

1. Tissue engineering and biomaterial

Here biologically compatible scaffolds are implanted at the site where new tissue is to be formed. This will attract cells and give rise to a new tissue of the desired shape.

• Cellular therapy

This is also known as stem cell transplantation which will be discussed in more detail later in this article

• Medical devices and artificial organs

Although we consider regenerative medicine as an emerging field in medicine, it has its roots set way back in history. A common example is the tale of Prometheus that appeared in 8th century BCE. Prometheus, an immortal Titan in Greek mythology who stole fire and gave it to humanity for them to use, defying the gods in consequence. As punishment, Zeus decreed that he was to be bound to a rock where an eagle would feast on his liver every day and said liver would regenerate itself every night, leading to a continuous loop of torture. There are many other legends as this one in different cultures suggesting that regenerative medicine is no new concept to mankind.

However this became a possibility once  scientists like Alexis Carrel (who invented the technique of cell culture) were finally able to keep cells and tissues alive outside of the body allowing  them to study the mechanisms of cell renewal, regulation, and repair. The initial trials began by experimenting on the largest and most well known regenerative organ of the human body, the skin. The very first product of regenerative medicine called as the Epicel was created in 1979. This technology consisted of isolating keratinocytes from a skin biopsy and having them proliferate outside of the body to make cell “sheets” that were then used as an autologous treatment for burn patients. The next technology was Apligraf, found in 1981 which could regenerate both the dermis and epidermis of the body. Scientists were also looking into cartilage regeneration at the same time. The next big step in regenerative medicine was the discovery of stem cells and the coining of regenerative medicine with stem cell transplantation. By this time many scientists were invested in this field and many discoveries were made in the following years such as, the implantation of a genetically engineered bladder in 2006 and the widespread use of hematopoietic stem cell transplants as a curative therapy for blood disorders and immunodeficiency. Thus the field of regenerative medicine was booming!

There are 4 types of regenerative medicine being used at present.

1. Stem cell treatments

Stem cells are the body’s raw materials from which differentiated cells arise. In regenerative medicine, stem cells are being guided to give rise to the organ that we need. People who might benefit from stem cell therapies include those with spinal cord injuries, type 1 diabetes to reduce the progression to complete insulin resistance , Parkinson’s disease, amyotrophic lateral sclerosis, Alzheimer’s disease, heart disease to strengthen the heart, stroke, burns to regenerate the lost skin, cancer and osteoarthritis.

• Cartilage regeneration

Healing of cartilage is difficult due to its poor blood supply. This technology is used to regenerate the musculoskeletal system. Healthy cartilage is taken form the damaged joint and grown in vitro and then the new cells are injected to replace the damaged tissue.

• Platelet rich plasma (PRP)

This concept is based on the belief that platelets posses a regenerative capacity. Blood drawn from the patient is centrifuged and concentrated platelets are injected back to the site needed.

• Prolotherapy

In prolotherapy, a doctor injects a watery solution containing substances like saline and dextrose into the injured area. These injections usually contain a numbing agent like lidocaine as well.The injection irritates the injury site, triggering the body’s healing response. As a result, the body will grow new connective fibers to repair the damaged tissue. 

Currently a vast number of FDA approved products are available on the markets and are being used in the curative as well as preventive aspects of medicine. Biologics such as autologous fibroblasts in improving nasolabial fold appearance, autologous chondrocytes for cartilage defects, cord blood for hematopoietic stem cells for immune reconstitution are used. Also cell based medical devices like dermagraft with allogenic fibroblasts for the healing of diabetic foot ulcers, cell extractions like cellution to transfer autologous adipose stem cells are being widely used. Bio pharmaceuticals like platelet derived growth factors are being used for periodontal defects and diabetic foot ulcers.

Although the field of regenerative medicine had seen many advances, it has much more potential. Many researches are being carried out and many new developments are being made.New inventions are being studied, such as bioengineering livers, tendons and artificial vascular systems.

There are a few challenges such as regarding the safety following a stem cell transplantation. How will they continue to grow? Will it be harmful to the recipient? Hence tight regulation and monitoring is required. Secondly, vascular anastomoses fro the newly regenerated organ with the host vascular system is needed. This could be tricky and should be done with care to prevent further complications. On the other hand more studies are required to find out about how age, diseases state and micro biome of the recipient will affect the regenerative capacity.

However to date the filed of regenerative medicine has led to life changing discoveries and will continue to do so. It’s almost as if the field is itself regenerating!

References

Dr. Nael Shanti. 2021. 4 Types of Regenerative Therapy Treatments – Dr. Nael Shanti. [online] Available at: <https://www.shantispinesurgery.com/types-of-regenerative-therapy-treatments/> [Accessed 20 October 2021].

Greenwood, H., Thorsteinsdottir, H., Perry, G., Renihan, J., Singer, P. and Daar, A., 2006. Regenerative medicine: new opportunities for developing countries. International Journal of Biotechnology, 8(1/2), p.60.

Jacques, E. and Suuronen, E., 2020. The Progression of Regenerative Medicine and its Impact on Therapy Translation. Clinical and Translational Science, 13(3), pp.440-450.

Mao, A. and Mooney, D., 2015. Regenerative medicine: Current therapies and future directions. Proceedings of the National Academy of Sciences, 112(47), pp.14452-14459.