Historical accounts of colonial science and medicine have failed to engage with the Colonial Office’s shift in focus towards the support of research after 1940. A large new fund was created in 1940 to expand activities in the colonies described as fundamental research. With this new funding came a qualitative shift in the type of personnel and activity sought for colonial development and, as a result, a diverse group of medical and technical officers existed in Britain’s colonies by the 1950s. The fact that such variety existed amongst British officers in terms of their qualifications, institutional locations and also their relationships with colonial and metropolitan governments makes the use of the term ‘expert’ in much existing historical scholarship on scientific and medical aspects of empire problematic. This article will consider how the Colonial Office achieved this expansion of research activities and personnel after 1940. Specifically, it will focus on the reasons officials sought to engage individuals drawn from the British research councils to administer this work and the consequences of their involvement for the new apparatus established for colonial research after 1940. An understanding of the implications of the application of the research council system to the Colonial Empire requires engagement with the ideology promoted by the Agricultural Research Council (ARC) and Medical Research Council (MRC) which placed emphasis on the distinct and higher status of fundamental research and which privileged freedom for researchers. Our existing accounts of colonial science and medicine in the twentieth century have failed to grasp the extent to which the Colonial Development and Welfare (CDW) Act of 1940 represented a major turning point in the history of the British Colonial Empire. There is a tendency in accounts of the medical services in the British Colonial Empire to discuss the post-war period superficially, if at all.The work of historians such as Christophe Bonneuil and Joseph Hodge have done much to elucidate the role of agricultural officers who worked on development schemes in Africa after 1940.This paper will describe the new arrangements that were introduced to accomplish the substantial expansion of research in Britain’s colonies after 1940 and consider the reasons for the eventual form of these arrangements. The argument that will be made is that an understanding of the novel machinery introduced for colonial medical and agricultural research after 1940 requires an appreciation of developments in the organisation of research at home. The research apparatus introduced for the Colonial Empire was informed by a liberal ideology of research that had become institutionalised in Britain with the rise of the research council system. This ideology promoted the claim that research could only really flourish if conditions were provided for individuals in which they had freedom to work. Freedom in this case meant the absence of interference from those who lacked experience of carrying out research themselves. This could include politicians, civil servants and even scientific, medical and technical staff, if their work was not judged to involve research. This rhetoric worked to enhance the standing of the research councils. The Agricultural Research Council (ARC) and Medical Research Council (MRC) claimed that, unlike government departments at home and in the colonies, research councils were bodies governed by experienced researchers and therefore only they were qualified to administer research. The notion that the research councils were the true bastions of research in Britain was taken to its extreme by the MRC who worked to subsume all medical research in Britain within its control.When the Colonial Office came to formulate plans for a substantial expansion of agricultural and medical research for the colonies in the 1940s it turned to the Agricultural Research Council and the Medical Research Council. Officials at the Colonial Office did this because they believed they were moving into a new area of administration where advice would be necessary but also because the involvement of representatives of the research councils was considered essential in order to raise the prestige of colonial research so the Colonial Office could attract high-flying research staff. By 1947 the Colonial Office had created ten new committees in London to administer money from the research allocation of the CDW Acts.This assertion of metropolitan expertise when it came to the introduction of a substantial expansion in research in Britain’s colonies after 1940 is not recognised in the existing literature. It was a deviation from the trend that had been occurring before 1940. In East Africa plans had been formulated during the late 1930s for the creation of new regional bodies to co-ordinate research in medicine, agriculture and veterinary science. The initiative for the Standing Medical Research Committee proposed in 1936 came from doctors and entomologists based in Tanganyika, Kenya and Uganda and reflected a desire for better organisation and funding that had arisen at the colony level.As the 1940s progressed, the Colonial Office had to balance a number of competing concerns. Initially the priority of the Colonial Office was the recruitment of highly capable research staff to work on the expanding range of research schemes. During the course of the second half of the 1940s other issues came to the fore, however, including the need to appreciate rising political consciousness amongst colonial peoples. By the early 1950s the Colonial Office was attempting to place limits on the autonomy and power held by the CMRC on the grounds that representatives of the MRC were too ignorant of the changing political conditions in Britain’s colonies to be allowed sole responsibility for medical research.The period between World War I and 1950 saw scientific research move from being an area that was said to be neglected in Britain to a field of intense state interest.From this narrative we might come to the conclusion that research in Britain was the sole preserve of the universities and research councils. In historical accounts of the period between 1914 and 1950 the science undertaken by government departments has in fact often been overlooked. One exception is the work of David Edgerton which has done much to transform this picture of the rise of state-funded science in the first half of the twentieth century by showing that spending on research by the Service Departments – the Admiralty, Air Ministry and Navy – was in excess of that of the civil research councils.In addition to recognition of the large proportion of state funds that were spent on research by military departments, we need to adjust our narrative of the rise of research in Britain by recognition of the very large commitment to colonial research from 1940 onwards by another government department, the Colonial Office. The passing of the 1940 Colonial Development and Welfare Act created a Research Fund of The resolution to this problem was the appointment of a number of committees at the Colonial Office that were populated by eminent scientists, many of whom were associated with Britain’s research councils.In June 1945 the Colonial Office formed a new committee to oversee the expansion of research in agriculture, veterinary science and forestry. This was the Committee for Colonial Agricultural, Animal Health and Forestry Research or CCAAHFR. As with the other research committees that were formed at the Colonial Office between 1942 and 1947, the CCAAHFR contained members drawn from the domestic research councils, in this case John Fryer, Frank Engledow, John Simonsen and John Smith from the ARC.The new committee for agricultural research differed from the pre-existing body that provided the Colonial Office advice on agricultural policy, the Colonial Advisory Council of Agriculture, Animal Health and Forestry.Colonial Office officials agreed with the scientists they had recruited on the need to use the research fund to introduce a comprehensive array of programmes of fundamental research. Fundamental research was defined as long-range studies of widespread and basic problems and the acquisition of knowledge through this work about conditions in Africa, for example, was said to be crucial to the successful development of Britain’s colonies after 1940. Officials supported the claim by members of its new research committees that, for fundamental research to prosper, research workers must be given a degree of independence from the existing colonial administrations. In 1946 Charles Carstairs wrote to the Central African Council to explain that the intention of the Office in promoting fundamental research was to support ‘long term work bearing on the basic problems of an area, best conducted on a semi-independent basis’.It implies on the one hand some degree of independence of local administrations, except for disciplinary purposes, and on the other hand scientific control by scientists of assured reputation. The Secretary of State has sought to meet these requirements by giving to the appropriate Research Committee a special position of independence. While nominally the Committees are advisory, he has undertaken to be guided by their advice in scientific control of research workers in all save the most exceptional of circumstances.The notion of freedom for researchers, and also the committees in London that oversaw their work, was explained in a Colonial Office note to the Conference of African Governors of 1947: Colonial governments were not only expected to accept that their research needs were to be overseen by committees based in London, they were also expected to agree to the creation of research laboratories in their territories over which they would have very little control.With the creation of the CCAAHFR the Colonial Office endorsed an approach to organising agricultural research that set out to reproduce in the colonial context the type of arrangements that existed for agricultural research at home under the ARC. The focus of the CCAAHFR was on the formation of new research institutions that would operate with some autonomy from the existing Departments of Agriculture in the colonies. It was agreed that new laboratories in the colonies should be created that served groups of colonies on a regional basis rather than smaller institutions for each individual colony. It was hoped that specialist staff would be appointed to a new Colonial Research Service.Detailed recommendations for new regional organisations were endorsed by the East African authorities at a conference on agricultural and forestry research in Nairobi in July 1947.We doubt whether anyone who has not been an active research worker for a part of his life can effectively lead a research team with the understanding and appreciation that will bring out the best of which members are capable.The place of the regional research organisations in the plans of the CCAAHFR for colonial agriculture was explained in a document published in 1948.The normal administrator, with ideas based on command and orderliness, must find it difficult to accept a position as a leader of a group of individualists; and attempts to impose discipline or order on the research worker can be fatal to productive research.In an earlier draft of the same document, Storey had been more explicit in his reasons why agricultural officers who were administrators in the Colonial Agricultural Service and did not possess research experience were not suitable individuals to supervise the work of agricultural researchers. Arguments for the placing of responsibility for overseeing research into the hands of scientists who had themselves forged careers in research drew upon the independent status of the ARC’s research units in Britain for their power. The CCAAHFR stated that it wished to introduce to Britain’s colonies units for research similar to those that the ARC and MRC administered at home. In Britain agricultural research institutions such as the Rowett Research Institute were directed by researchers who reported to the ARC. The ARC, like the other research councils, was controlled by a committee composed of academic scientists who were in turn accountable to the Privy Council rather than a minister with departmental responsibilities. The significance of this arrangement was said to be the fact that the work of the units was determined by researchers with relevant experience and removed from the narrower interests of government departments.With the creation of EAAFRO and EAVRO the CCAAHFR had achieved its goal of creating new regional laboratories headed by experienced agricultural researchers. Keen and White had responsibility for the content of the research that was done in their institutions, in communication with the CCAAHFR. They did not have to seek approval for their research plans from the Director of Agriculture employed by the governments of Kenya, Tanganyika or Uganda. The CCAAHFR expressed its desire to see the full support of colonial authorities for this arrangement.Some degree of decentralisation when it came to organising agricultural research, with some responsibility devolved to bodies in Africa and attention paid to local demands, was entirely in keeping with Colonial Office policy from 1947 onwards. Under Arthur Creech-Jones the Colonial Office had moved away from its stance of the early 1940s in which it has sought direct interference in colonial affairs. This earlier approach had been prompted by frustration over the slow rate of progress in colonial development, attributed to the laissez-faire attitudes of the past, and inadequacies of the colonial administrations when it came to planning development.The CCAAHFR intended that co-operation in the colonial territories would be achieved through the creation of regional councils for agriculture, animal health and forestry upon which would sit the Directors of EAAFRO and EAVRO, representatives of the colonial departments, agricultural producers and officers from local commodity research stations. This would allow the local agricultural departments to make recommendations for research. There were, however, limitations to how much local influence over research was acceptable to the CCAAHFR. The role of the regional councils was to be advisory rather than executive, ensuring that the Director of Research of EAAFRO and EAVRO was not in a subordinate position to any local Director of Agricultural Services .The arrangements for research introduced by the CCAAHFR in East Africa after 1945 reconfigured the relationships amongst agricultural staff that worked in the region. Members of the existing Colonial Agricultural Service were officers who had contact with African farmers and instructed them in farming techniques. They were engaged by other members of the colonial administration to implement development policies such as soil erosion control or resettlement schemes. The increasingly large numbers of agricultural researchers working in institutions such as EAAFRO and EAVRO did not necessarily have any direct contact with African farmers but worked in relatively self-contained research institutions where they might be entirely involved in laboratory work such as developing vaccines. They had some independence from the Departments of Agriculture and the Colonial Administrative Service and a closer relationship than other agricultural officers with London-based committees. Agricultural expertise after 1940 therefore was more differentiated than many existing accounts of experts in Africa would currently indicate and importantly these individuals did not all have the same relationship with the colonial state and colonial peoples. Paying close attention to such differences in role is important if we are to produce more nuanced understandings of the role of agricultural expertise in the late colonial period. The creation of large organisations for agricultural and veterinary research after 1940 would seem to question the claim that one of the problems with expert-led interventions in Africa was a frequent absence of good understandings of the African environment.The CCAAHFR argued that the best way to greatly expand fundamental research in agriculture in the colonies was to create new institutions that would prove attractive to research staff by giving researchers the freedom to pursue their work without interruption. The approach of the CMRC was different. Rather than focus on the formation of new institutions in the colonies the CMRC insisted that medical research would flourish if the committee itself had a prominent role in determining the choice of research projects and the selection of medical research personnel. Control over the appointment of researchers was a priority for the CMRC in a way that it never was for the CCAAHFR. The premise was that the quality of medical research in Britain’s colonies was predicated on the quality of researchers, and only the MRC was in touch with medical researchers of merit. In addition, the direction of medical research activities in the colonies by the CMRC in London was considered essential. Medical research workers were said to only be willing to work on projects in which it was clear that the MRC was the authority as only the presence of members of the MRC could reassure researchers that the right conditions would be provided for their work. This effectively meant that colonial administrations, including members of the existing Colonial Medical Service, could not necessarily expect to have much say in the future direction of medical research.At the initial meeting of the CMRC, A. Landsborough Thomson emphasised the importance of the principle that progress in colonial medical research would depend above all else on securing the services of the most able researchers, ‘It was important to begin by choosing suitable men and giving them considerable freedom in their choice of subjects.’In general, however, the CMRC claimed that the introduction of proper research would be achieved by the deployment of new workers to the colonies and not by encouraging existing members of the Colonial Medical Service to carry out more research. Mellanby was recorded as saying at a meeting of the CRC in 1942 that, ‘much of the research that was being done at present was ”jobbing” research and not what he described as the real thing. The problem seemed to be to superimpose the real thing on present institutions’.If the CMRC adhered to the principle that an expansion of high-quality medical research in Britain’s colonies would require an influx of new personnel who had been selected for this purpose by the committee itself, then the second principle that it promoted was that colonial medical research must be under the central direction of the CMRC in London. Research projects were generally suggested by individuals who sat on the committee rather than colonial medical departments. The focus of the schemes nominated by the CMRC was predominately on a list of nominated tropical diseases Table .50  TwThe CMRC made arrangements between 1945 and 1950 to take over existing research institutions in the colonies and to set up a number of new units. It accepted the offer made by the Rockefeller Foundation to take on the virus research centres at Entebbe, Uganda and Lagos, Nigeria and it also accepted responsibility for a laboratory at Freetown in Sierra Leone that had belonged to the Liverpool School of Tropical Medicine.Many investigations supervised by the CMRC had a component that consisted of laboratory experimentation and this was often done in research establishments in Britain such as the Liverpool and London schools of tropical medicine, the MRC’s own National Institute for Medical Research or the Lister Institute. In many cases, the MRC funded metropolitan work, leaving investigations that required fieldwork in the colonies to be financed using the research fund. The CMRC wished to see the movement of research staff between centres of tropical medicine in Britain and the colonies, and also movement between different locations in the Colonial Empire. Regular contact with metropolitan research organisations was said to be crucial in order to attract outstanding researchers. High-flying medical research workers were said to be in great demand and colonial research would only be able to attract these individuals if the arrangements for the administration of research fulfilled certain criteria. As well as the freedom for researchers to choose their own research projects, the CMRC identified the central direction of the research service by its own academic members as key. Central co-ordination of research by the committee in London would enable researchers to be in close contact with ‘the world of research’ which included ‘the general stream of research in the centres of learning at home’. In addition, the movement of research workers freely between colonies was necessary since ‘only by deploying research workers as opportunity offers can effective use be made of the limited resources of the first-class scientific manpower available’.the CMRC has considered that a different form of organisation would be preferable for medical research so as to keep medical research workers in East Africa in close contact with medical research in the UK and the rest of the Empire.The fact that the CMRC chose and planned many of the research schemes to be done, personally selected research staff, and then directly administered and supervised much of this research amounted to a large degree of central direction by this body. This creation and direction of research projects by the London committees was not unusual and was a practice that the CCAAHFR, for example, was involved in at times through its sub-committees dealing with cocoa, fertilisers or stored products. The CMRC, however, dealt with a relatively small number of projects proposed by colonial administrations. In comparison to the CCAAHFR, the CMRC was reluctant to consider alternative arrangements for administering research schemes that might involve devolved responsibility to organisations in the colonies, or collaboration with local administrations. The CMRC noted in 1947 that it was aware that regional bodies to co-ordinate research were planned for agriculture and veterinary science in East Africa but: The committee expressed the view that, whilst researchers should cultivate cordial relations with the colonial governments and observe their regulations for discipline, ‘in all research matters they will be outside the jurisdiction of the authorities of the Colonial Territory which they work’.The key to successful medical research was, as it had been with agricultural research, freedom for high-calibre research staff to pursue their work without interference. The threat to long-term fundamental investigations came from members of the colonial administrations including existing scientific and medical officers who, it was claimed, had little experience of research. In the case of agricultural research, freedom of action had been achieved by the creation of large new research organisations that removed agricultural researchers from the control of the Departments of Agriculture. In the case of medical research, freedom of action was to be achieved less as a product of new research laboratories and more as the outcome of the complete authority over medical research that the CMRC sought from London. Medical research workers, who might move between different metropolitan and colonial locations, were accountable to the CMRC, and not to any colonial administration. This was desirable, it was claimed, as the MRC was the pre-eminent authority in the field of medical research and only its members could determine the conditions that medical researchers required to undertake their work. In addition, medical research in the colonies would only have sufficient cachet to attract the most able workers if it were clear to these individuals that they would effectively be working under the aegis of the MRC.One outcome of the complete authority over medical research sought by the CMRC was the marginalisation of existing medical staff of the colonies when it came to the organisation of research during the 1940s. Individuals in the medical, tsetse and game departments of the East African colonies before World War II had hoped to create inter-colonial committees to deal with disease problems and to collate information on health that would operate on an East African basis. In 1936 a Standing Medical Research Committee was approved by the East African Governors and met in August of that year.When it was faced with the issue of how to expand its research activities after 1940 the Colonial Office decided that the involvement of eminent scientists drawn from the research councils in Britain would be necessary in order to confer upon colonial research a sufficiently high status to attract good-quality research workers. The CCAAHFR and the CMRC were created with this object in mind, with representatives of the ARC and MRC appointed to these committees so as to allow the research council model to inform new arrangements for colonial research and to bring this work into closer contact with domestic institutions from which high-calibre research staff might be recruited. The relationship between the CCAAHFR and officials at the Colonial Office was very good. In contrast, relations between the CMRC and the Research Department of the Colonial Office became increasingly fraught during the 1940s.Good relations with the MRC were considered by officials to be key if the Colonial Office was to achieve its aim of securing the services of British medical researchers for new projects in colonial research. In the years leading up to 1947, the Colonial Office concurred with many of the plans of the CMRC and the other research committees, including freedom of action for researchers, the creation of a new research service, and a degree of central direction in research. The Colonial Office believed that it had given the research committees a degree of autonomy that was unprecedented, considering that these committees were staffed by individuals who worked on a voluntary basis and were involved in the organisation of colonial research only through the invitation of the Office. It became increasingly clear during the course of the 1940s that not only was the CMRC unappreciative of the efforts of the Colonial Office to meet the requirements of the scientists it worked with, the committee could be openly hostile. It became apparent that the CMRC aimed to force the Colonial Office to relinquish control of funds for medical research in the colonies to the MRC.The issue was that the MRC prided itself on the fact that it was not a body that submitted to any other authority when it came to matters of medical research. The first Secretary of the MRC, Walter Morley Fletcher, is said to have firmly believed that all funds for medical research should come under the purview of the MRC as it was the only body in Britain capable of judging the worth of research proposals in medicine. The council had a tendency to absorb other bodies in Britain concerned with medical research. In the inter-war period the MRC’s desire to be the pre-eminent authority in matters of medical research in Britain caused some friction between the MRC and other institutions, including the Ministry of Health and the Royal Colleges.It will be common ground that, in order to achieve the maximum of success, any investigation conducted in a Colony must have the good-will and co-operation of the Colonial administration concerned. The Secretary of State is not in a position to order any particular investigation to be carried out in any particular territory. The government of the territory has to be asked in the first place whether it agrees to the investigation being carried out and how soon.A number of issues served as flash points. One was the desire of the CMRC to appoint and deploy workers as it saw fit, freely moving researchers between colonies, and to metropolitan research institutions, at will. In practice, the recruitment and movement of researchers required co-operation and agreement between the Colonial Office, the Treasury and colonial governments. The CMRC failed to appreciate the nature of the relationship between the Colonial Office and the colonial governments in particular. The Colonial Office clarified its position in 1950: The CMRC would not acknowledge the necessity of a diplomatic approach by the Colonial Office when dealing with colonial governments, however, and accused the Office of inefficiency and inflexibility when it came to the deployment of new medical research staff.The Committee, as you will see, is an advisory body. But with the precedent before them of the independence of the MRC from the ordinary administrative machine in Whitehall, they have always taken the view that medical research policy must be controlled and administered solely by medical research men.The arguments of the CMRC were almost entirely geared towards preserving the MRC’s ultimate authority over researchers, and therefore colonial medicine, without having to endure the scrutiny of either the Colonial Office or the Treasury for every decision it made. The CMRC, dominated by individuals closely associated by the MRC, if not appointed by this body, was adamant that medical research must in no way be influenced by the concerns of government departments, and it used the position of the MRC itself as an exemplar, referring to its relationship with another government department, the Ministry of Health.This desire to ensure that it was scientists who had ultimate control of the research agenda and not administrators was also reflected in the arguments employed by the CCAAHFR to secure autonomy for researchers in East Africa from the colonial departments. However, whilst the CCAAHFR was most concerned with new forms of organisation for research within the colonies themselves, the CMRC was preoccupied with its own status, and that of the MRC, with respect to the Colonial Office.The Colonial Office strenuously resisted the attempts of the CMRC to obtain complete control of medical research funded with the CDW allocation. Officials complained that the CMRC had proven to be a particularly uncompromising and uncooperative body of experts, something that was ascribed to the dominance of the committee by the MRC, and the personality of Mellanby.By 1950 it was clear that the desire of the CMRC to direct research in Africa from London, and its willingness to disregard the political conditions that existed in individual colonies, put it increasingly out of step with the trend in official policies and developments in the colonies themselves. In March 1950 the Colonial Office had produced its formal response to the demands that control of medical research for the colonies be transferred to the MRC. Apart from the constitutional reasons why the Secretary of State was unable to devolve his responsibilities for Colonial Development and Welfare to another body, the Colonial Office made it clear that it was not acceptable to impose medical research upon territories which were moving towards independence and where local peoples were increasingly represented on local legislatures. With regard to the native inhabitants of the colonies, ‘It is part of the process of education for self government that they should appreciate the value of research and they will not appreciate something in which they have no share’.practically all schemes of development and research have a political aspect, and the decision on any questions of policy or politics affecting the peoples of Colonial territories must rest with the Colonial Office administrative staff and the Colonial administrations.Colonial Office attitudes towards the colonial administrations, and the people that lived under British rule, had undergone important changes since the beginning of the 1940s. The policies developed by Andrew Cohen now held that services within each colony should gradually be placed in the hands of African peoples operating through local government, and that relations with the colonies should be based on advice and consultation. Opposition to British rule produced violent unrest in the colonies: riots in the Gold Coast and the declaration of a state of emergency in Malaya in 1948. The views of the British medical establishment now seemed high handed at the least, and were perhaps even likely to cause serious dissent amongst colonial populations. The demands of the CMRC, therefore, that responsibility for colonial medicine be handed over to the MRC were quite unacceptable to the Colonial Office. As summed up by Hibbert: In order to effect some compromise with the CMRC, separate and more favourable scales of pay for medical workers based on those used by the MRC were introduced for the Colonial Research Service. The membership of the CMRC was altered, however, to include a greater proportion of individuals who were considered to support the Colonial Office view on research, such as individuals drawn from the Colonial Medical Service.The fact that the Colonial Office decided to appoint representatives of Britain’s research councils to oversee the spending of its research fund tells us something significant about the place of the research councils by the mid-twentieth century. The DSIR, ARC and MRC did not command the largest funds for research in Britain – more money was spent by the Service Departments; and yet it was these bodies that defined the very nature of research. They had achieved the position of pre-eminent authorities on the true nature of fundamental research and the conditions necessary for its successful prosecution. The high status of the ARC and MRC was predicated on the notion of freedom. The research councils, it was said, were not subordinate to the authority of civil servants and politicians and they ensured conditions for their researchers that served to encourage free enquiry. The development of the research council system in Britain was more than just the expansion of state funds for science, it was the establishment of a particular rhetoric about the nature of research and how it should be nurtured.Whether or not officials at the Colonial Office subscribed to this liberal ideology of research, when it came to the expansion of colonial research after 1940 officials believed that explicit research council involvement would be essential for recruitment. A different type of scientist or medical worker was sought for work in the colonies after 1940 to those who had previously been recruited to the technical services. The Colonial Office wished to see expansion in numbers of high-calibre researchers – scientific specialists who most likely were currently working at a university or research unit in Britain and were in receipt of research council funds. The appointment of members of the ARC and MRC to new committees was intended to give the Colonial Office direct access to these individuals and it was hoped that the supervision of colonial research by committees such as the CCAAHFR and CMRC would give this activity the prestige it needed to be attractive to such workers. The CCAAHFR and CMRC were given a great deal of freedom in the early years of their work and set about organising research in agriculture and medicine with little interference from Colonial Office officials.Both the CCAAHFR and the CMRC referred to the organisation of research at home by the research councils in their proposals for new apparatus for colonial agricultural and medical research. The notion that modelling colonial research on domestic arrangements was the most appropriate thing to do was not initially challenged by the Colonial Office, even though objections were raised by members of the technical departments in the colonies. Officials accepted the claim that the special nature of fundamental research meant that it required new arrangements. They also accepted the claim that no existing officer in the colonies was qualified to oversee this activity. What is striking here is the extent to which the activity of research was treated as something that had far greater cachet than other technical, scientific or medical work. The distinction that was made by the committees in London between fundamental research into general issues and short-term solutions of local problems was made concrete with the creation of separate research institutions in the colonies and a new Colonial Research Service. Scientific specialists employed for colonial research after 1940 and agricultural officers, doctors and veterinary officers did not necessarily work within the same colonial apparatus. The consequences and implications of the heterogeneous system of expertise this produced have not been examined by historians. We have yet to consider the legacy of the involvement of the ARC in creating semi-independent agricultural research organisations such as East African Agricultural and Forestry Research Organisation (EAFFRO). In addition there is the question of the significance of the emphasis placed by the MRC on the mobility of medical researchers in shaping the nature of colonial medical knowledge.By the late 1940s officials at the Colonial Office were starting to raise some concerns about the organisation of colonial research and from 1947 there was an increasing desire to see better communication between those who were most in touch with the needs of the colonies and those who determined the research agenda. Of the two councils formed to deal with agricultural and medical research, the CCAAHFR displayed the more collaborative approach to dealing with the issue with its members acknowledging a role for agricultural officers in the colonial administrations in determining the direction of agricultural research. In the case of the CMRC, however, officials discovered that the appointment of a committee that contained many members of the MRC had given the MRC the opportunity to claim funds for colonial medical research for itself. The rhetoric that worked to elevate research and the research councils above other activities and bodies in the field of science and medicine was now being used to argue that only the MRC was qualified to administer Colonial Office research funds.When it came to who was the final authority in matters related to the organisation of colonial research, the Colonial Office had asserted itself by 1950. Officials endorsed the principle of independence for research workers, as long as the actions of these workers did not appear to offend either the colonial administrations or the local populations of the colonies. It did not accept, however, that the specialist committees in London could be entirely left to take the initiative in organising colonial research. By 1950 Colonial Office officials believed that the expertise they possessed with respect to the social and political issues of the colonies was more valuable than any special expertise in research.


Progress of the IUPAC InChI/InChIKey project continues to move ahead with many new features and support. A collection of four short videos explaining the InChI project have been produced and are available via the InChI Trust web site. Use of the algorithm has increased over the past year to the point that numerous publications use and refer to InChI. Publicity for the project is good and has resulted in considerable increase in the usage of the InChI algorithm. The Trust web site is now available to the public and is updated regularly. Even CAS now allows for an InChI string to be used as input for a SciFinder search and the Sigma-Aldrich catalogue is InChI searchable. Extensions to the project’s current capabilities, such as InChI for chemical reactions, are being developed by a number of expert, experienced individuals and groups from various areas of chemistry. This poster presentation will describe the current technical state of the InChI algorithm and how the InChI Trust is working to assure the continued support and delivery of the InChI algorithm.


As the field of Psychology evolves there is much interest in understanding how educational practices can be shaped to facilitate the recruitment and engagement of students . Educating means getting people to be excellent scholars, and translating this into the skills and competencies that employers seek in graduate recruits, helping students to see that psychological literacy and an appreciation of the dialectic in psychology and our methodological pluralism offers valuable ways of seeing and understanding, and helping students to learn from and understand the central importance of being and becoming through study.By designing academic programmes around the various stages of the learning process described above one can be sure that such programmes are not only effective in delivering a relevant curriculum but one that attracts, engages and retains enthusiastic and talented students to the field. There is no doubt that Rees  should b


There is global inequity in medical research both in terms of populations who do not have access to the best evidence-led health care and in medical and scientific staff taking part in research studies. Alongside this is international recognition that trials have become overly cumbersome in their operation and regulation and that they are too expensive. There is widespread agreement that there needs to be changes in the way trials and designed and operated in order to make them more pragmatic and thereby attractive and viable for would be researchers (and their funders). A common compliant is the lack of published examples and best practices in operational approaches in running clinical trials. Here we report our on-going research methodology study that follows the steps and processes that are involved in setting up a highly pragmatic randomised clinical trial in Ethiopia and create a process map to report how the study was initiated and then subsequently operates. The primary object of this study is to determine all the issues and challenges that the trial team faces. Secondary objectives include an analysis of the study metrics, experience data from the study personnel and whether any lessons or solutions can either be shared or turned into a tool that others can benefit from for future studies.


After the publication of this work  it was bFollowing approval from the institutional ethics committee, the family of all patients in this study provided written consent to participate in this study, along with consent to publish their clinical details and photographs.


Sir,We have read the letter2The authors of the letter failed to understand the reasons for performing plating along with acetabular fracture fixation. The authors preoperatively planned for the digastric osteotomy after reviewing the CT scans in detail. As reported in the article, the posterior wall fragment was superior in location and could not have been accessed adequately without the trochanteric digastric osteotomy. It helped in preventing the devitalization of the gluteus medius muscle by the otherwise strong retraction.We have discussed the rationale of using dynamic condylar screw along with antirotation screw for the reverse oblique fracture of the trochanter combined with neck femur fracture in the discussion. This case was operated nearly three years ago and at that time, the intramedullary devices as suggested by the authors of the letter were not available with us. Moreover, even now, such a nail is not considered ideal for the above indication even by the manufacturers themselves. We thank the authors for bringing the issue of varus which made us go back to the drawing board, and after reviewing the radiographs of both sides of hip joint, it was found that the difference was less than 5 degrees in both the hips. In all the cases in the literature also, the mode of treatment has been enumerated and most of the authors in different countries working under different work conditions have opted for the DCS with antirotation screw, which shows its versatility and also the benefits.4We followed the worldwide accepted protocol for DVT prophylaxis


This poster will outline the psychology services available to inpatients and outpatients who present for treatment at the Royal Melbourne Hospital Eating Disorder Unit. A brief outline of the inpatient, outpatient, and daypatient psychological services will be provided with clear rationales for the basis for offering the service delivery approaches. In addition, the role psychology on the unit as a function of a multipdiscplinary team and therapeutic milleu will be outlined. Future directions for psychology and the role the psychologists working on the unit play in research projects and areas of research interest will also be outlined in this poster.


What is the role of chance in evolution? How does this force influence the adaptionist view of evolutionary biology? Written by one of the leading researchers in the field of evolutionary and computational biology, Koonin  providesAlthough not for the more timid lay reader with text in places being very dense and acronym laden, summary boxes and synopses at the end of each chapter allow the reader to collect and consolidate essential ideas. Each chapter introduces novel ideas and although sometimes overly brief, the scientific research that has led to our current thinking. Whilst the chapters build from each other and would be best read in a single sitting , the density of the text means that this is unlikely in all but the most dedicated of readers.Early chapters of the text are aimed more at a general readership and provide detailed explanations and limitations of phylogenetic methods which are clear for those without prior understanding. These sections provide a comprehensive and stimulating review of the progress of evolutionary theory and experimentation. From Darwin and the central messages of the “origin of species” through an excellent introduction to the modern synthesis of the mid twentieth century to the “genomics revolution” of the latter twentieth and early twenty-first centuries.By comparison to the world of physics, the methods and theory of comparative genomics and evolutionary biology are used to investigate the possibilities of universals in evolution. Such as, is the network topology of interacting genes scale free due to the duplication of genes interrupting interaction of ancestral genes? Later chapters return to the area for which Koonin is best known, the comparative genomics and evolution of prokaryotes. Here the personal narrative is clear again and the importance of considering the prokaryote and eukaryote worlds as separated by differences in evolutionary history is emphasized. The complexity of evolutionary behavior of prokaryote organisms is discussed at length. The role of population genetics and population structure is introduced and this theory is used to highlight that the relatively long term stability of eukaryote genes is not shared in the turbulent world of prokaryote evolution. This theme of the necessity for different thinking when considering eukaryotes, particularly the animal kingdom, and the prokaryotes is discussed at length in relation to phylogenomics and the tree of life. The limitations of the universal tree of life with bifurcating branches representing the clear relationships between species are also introduced. Whilst, the tree of life is a tempting entity that is often used as a shortcut when discussing the evolutionary relationship of ancient homologous genes, the more realistic forest of life with interconnecting web or net like structure which incorporates the near ubiquity of gene swapping or horizontal gene transfer between prokaryotes is introduced.The theme of boiling down complex biological systems to physical universals is revisited when discussing the entropy or information content relative to genome size. The relative high entropy of “complex” eukaryote genomes which carry little information given their size is used as an argument against purely adaptionist thinking in the evolution of the genome. In contrast the non-adaptionist theory of genome evolution, reliant on the dominant effects of drift related to effective population size is used to highlight the prevalence of purifying selection in the prokaryotes. Here the author offers an excellent description and summary of the implications of work by Michael Lynch and John Conery on the non-adaptionist hypothesis of genome evolution. Eugene Koonin fluently introduces the theory of population genetics and its influence as a null hypothesis of genome evolution. Using the relatively simple explanations of Lynch and Conery, Koonin introduces the huge influence of drift on genome evolution. The author elegantly explains the process of how population dynamics influences genome size and complexity. Importantly the attractiveness and exceptions to these explanations are given using examples from comparative genomics. The book concludes with chapters on the hunt for and prediction of the form of the last universal common ancestor (LUCA), the origin of life and the problems with achieving understanding of this event. The author proposes that the term last universal common ancestral state (LUCAS) may be more accurate, and investigates the possibility of a non-cellular LUCAS.With this text, Eugene Koonin does not shy away from discussion of difficult issues. It is clear Koonin has not set out to preach to the converted but rather has aimed to challenge commonly held thoughts. The introduction and review of Wrightian and Lamarkian evolution and the potentially contentious issue of “evolution of evolvability” for example is achieved by eloquent and persuasive examples. In conclusion the book is a demanding but rewarding read, bringing together accepted research themes and deliberately challenging areas. Whilst those familiar with evolutionary biology and the author's work will find it a fascinating read, it is also well worth the perseverance for non-specialists to appreciate the complexity and role of chance in evolution.


Clinical guidelines from the National Institute for Health and Clinical Excellence recommend the use of an intramedullary nail for the treatment of subtrochanteric fractures.A routine preparation and approach to the greater trochanter is performed. The entry point is positioned medial to the tip of the trochanter. The cortex is breached and the guidewire passed in a direction aiming slightly from medial to lateral . This meAnatomical closed reduction of a reverse oblique fracture is difficult due to the pull of the abductors. Abducting the leg is often attempted to restore the normal neck shaft angle but this makes access for the procedure more difficult. We describe a simple alteration of surgical technique that can prove very useful in preventing varus malunion, improving functional outcome and speed of union. Readers should be aware that medialising the entry point without angulating the direction of entry leaves the potential for lateral translation, rather than rotation, of the proximal fragment .


During neural information processing, solving decision making problems or performing pattern recognition in any sensory modality, the brain can recognize objects as the same thing regardless of the stimulus intensity. The regulation of the internal representation under various levels of extrinsic stimulation is called gain control .However, the precise mechanisms for achieving effective gain control in the brain are unknown. Based on our understanding of the existence and strength of connections in the insect olfactory system, we analyze whether conditions exist that would lead to controlled gain. The question we want to address is to determine whether is possible to design stable neural circuits made of excitatory and inhibitory neurons capable of controlling the internal representation of the external stimulus using only the network properties. Using a mean field approximation for the network activity, we show that there is a precise relationship of network parameters that can account for stable internal representation regardless of the external stimulus. Our findings conclude that the most important network parameters are the connections from the inhibitory population to the rest. This is consistent with experimental findings . We also


As information progresses along the sensory pathway, it is transformed from physical attributes of a stimulus at the periphery to complex representations at the level of cortex that ultimately give rise to perception. Neurons at each stage in the sensory pathway are commonly characterized by simple linear models that describe the physical attribute of the stimulus that maximally excites the cell. However, neurons, even early stages of processing, can have strongly nonlinear characteristics that give sensory systems the remarkable capability to extract relevant information (features) from noisy environments (context conditions). In this work, we explored the bottom-up effect of stimulus context on the encoding of features in the whisker thalamocortical circuit of the anesthetized rat. The feature selectivity of thalamic neurons was quantified using spike triggered analysis techniques under three different stimulus context conditions . After characterizing each cell, the response to three features  embedded in each context condition were recorded, and ROC analysis was utilized to quantify the detectability of the stimulus in the presence of increasing levels of background noise. Neural responses to features embedded in each context condition were then analyzed as a function of the similarity between the embedded feature and the estimated feature selectivity of the cell to assess the discriminability of the feature from the background. Preliminary findings suggest that while the estimated feature selectivity is generally predictive of the thalamic response to presentation of isolated features, the linear models alone are not predictive of the thalamic response to features in different noise contexts. We hypothesize that this is due to a recruitment of nonlinear circuit properties by the higher amplitude noise stimuli. This hypothesis is supported by the reduction of spike timing reliability in the thalamic neurons as the noise amplitude increases, a finding that mirrors results in the visual thalamus and has been attributed to nonlinear circuit mechanisms . Future


Retinoblastoma is one of the more highly invasive and common intraocular malignancies of childhood. Treatment in most of the cases consists of enucleation followed by placement of orbital implants. Prosthetic rehabilitation is especially challenging in younger and precooperative pediatric patients. The following case report describes the rehabilitation of a 4-year-old child with retinoblastoma, with an ocular prosthesis fabricated by a simplified technique. For psychological, social and esthetic reasons ocular prosthesis should be fabricated as early in life as possible.The patient was a male child of 4 years, who reported to the Department of Ophthalmology with complaints of whitish spot on the right eye accompanied by bulging and squint, and pain on movements as narrated by his father. He was diagnosed with retinoblastoma and the enucleation was performed immediately. An orbital implant was not planned at the time of the surgery as regular periodic examinations were planned to rule out any recurrences at the optic nerve head, and placement of an implant could hinder early clinical and radiological detection. The patient was then referred to the Department of Prosthodontics for the fabrication of prosthesis .4 The procedure was initiated by selecting and modifying a prefabricated (stock) eye whose iris and pupil closely matched that of the natural eye, to comfortably and loosely fit the socket. This was duplicated with clear heat cured PMMA  and perforated for use as a tray in the impression procedure. Perforation of the tray was done to avoid any compression of the ocular tissues. The tray was placed in the socket and the patient was asked to gaze at a distant point to accurately mark the pupil as per contralateral side, on the tray.After examination and working out of treatment protocol, the work plan explained to the patient by simple diagrams and posters to gain his cooperation.A thin tube  was fabricated to serve as a handle for the impression tray and attached at the pupillary point for proper tray orientation during impression making . A thin 5 (to maintain a tear film over the prosthesis and to improve eye movements). Minor adjustments were made at the time of delivery as per the patient’s comfort and esthetics  to copy corneal translucency. The properly finished and polished prosthesis was inserted in the socket after being disinfected and lubricated with an ophthalmic lubricant (Ecotears)sthetics . Necessa6 Trauma is the most common cause for removal of an eye. The other common causes being glaucoma, malignancy, congenital deformities and infection. Retinoblastoma is the most common primary intraocular malignancy of the children which arises from immature retinal cells in one or both eyes between the ages of 6 months to 5 years equally in all races and both genders.7 Surgical removal of eye is the management in majority of the patients with unilateral retinoblastoma involving more than half the retina, though the induction of chemotherapy has modified this approach in many cases.8Anophthalmos is a condition in which no eyeball can be found in the orbit.Two options are available for artificial eye prosthesis, one is a prefabricated ocular prosthesis and other is custom made. Prefabricated eye prosthesis carry disadvantages of poor fit (which endangers the eye to granuloma formation), poor esthetics and poor eye movements. Custom made prosthetic eye fabrication involves complex painting procedures in various stages which are quite difficult and based purely on painting skills of the operator. The techinique to fabricate ocular prosthesis in this case report modifies a prefabricated eye prosthesis to a custom made fit and esthetics. This helped us to overcome the disadvantages of poor fit and esthetics of prefabricated prosthesis and complex painting procedure involved in making a custom made ocular prosthesis.3 Voids that collect mucus and debris, which can irritate the mucosa and act as a potential source of infection may also be minimized and this prosthesis also provides optimum cosmetic and functional results.3The purpose of this case report is to document a simpler technique for the fabrication of ocular prosthesis which does not depend much on artistic ability of the operator and is relatively easy to be performed by a dentist along with saving on laboratory time. The close adaptation of the custom made ocular prosthesis to the tissue bed provides maximum comfort and restores full physiologic function to the accessory organs of the eye.Limitations of this technique are that the clinician has to depend on the availability of properly matching iris and pupillary part in the prefabricated eyes available and the long-term color stability of the heat cured acrylic and its union with the stock eye will have to be monitored.


Focused ultrasound utilises powers of approximately 5000 to 10,000 times that of conventional diagnostic ultrasound which can be focused to a very small point in the tissues of the body where it produces rapid very intense heating which causes almost instantaneous ablation of heated tissues at the target site. No intervention is required and the whole process in this format is carried out within an MR scanner. MR allows excellent targeting of the site to be ablated and can provide an in vivo thermal map of heat delivery as it is deposited in the target tissue so that an accurate and very safe procedure can be performed as long as there is a suitable acoustic window available to reach the target site through the anterior tissues.This lecture will describe the areas where MR guided focused ultrasound has been utilised and will describe areas of evolving technology and the technological problems that are encountered in these applications. Whilst some of the applications described such as the utilisation of focused ultrasound in fibroids and in the brain are not directly applications that treat malignancy the principles of these treatments can be applied to other malignant disease processes and will in the future allow malignancy to be treated at these sites.nd FDA approved application of MR guided focused ultrasound is in the treatment of bone secondaries and the utilisation of focused ultrasound this area and its problems and potential will be described. MR guided focused ultrasound shows immense promise in the treatment of liver tumours but the technological problems in this application are huge and these will be described briefly and the methods by which we hope to overcome these problems will be provided. Focused ultrasound utilisation in the treatment of prostate cancer is one of the oldest applications of this technology and new transducers are now available utilising MR guidance which will substantially improve the complications seen with all types of prostate cancer treatment by providing excellent targeting accuracy of the deposition of destructive energy within the prostate and avoiding the neurovascular bundles.The largest experience in the world in this therapy is available in the pelvis in the treatment of uterine fibroids and this procedure will be described. The 2A brief description of the brain applications will be provided and although these are not malignant at the moment the future holds out significant promise in this field and this application is of great interest to all physicians in this field.st in human trials have not started yet but the promise that this type of approach provides is immense.Drug activation with focused ultrasound will become a very large field of its own and a very brief description of how this may work and what technologies are required will be given although this field has not yet entered the full clinical arena and 1


Oscillations are one of the hallmarks of neural network activity. They have been implicated in numerous cognitive phenomena and have been observed in many brain regions. What is interesting about the mechanism of oscillations in the cortex is that inhibitory neurons seem to play an important role in the generation and maintenance of these global oscillations. Yet, is currently unclear what specific properties of these inhibitory neurons shape the rhythms. One hypothesis is that their intricate synaptic connections are essential. Alternatively, the intrinsic properties of the neurons themselves could be the main factor. In the study presented here and recently published in , we expl


The purpose of this paper is to consider the role of the lifeworld perspective in reducing inequalities in health and we explain how the public health practitioner can use this perspective to address public health issues with individuals and groups. We offer ideas for public health actions that are based on and deal with the lifeworld context of individual people or families. Each of the dimensions of the lifeworld temporality, spatiality, intersubjectivity, embodiment and mood are outlined and their significance explained in relation to health inequalities. Suggestions for action to reduce health inequalities are made and overall principles of lifeworld led public health practice are proposed by way of conclusion. The principles comprise understanding the community members' lifeworld view, understanding their view of their potential, offering resources and facilitating empowerment, and sharing lifeworld case studies and lobbying to influence local and national policy in relation to both the individual and communities. This paper will consider the question of how the public health practitioner works to reduce health inequalities for individuals and groups in their practice context. A suggestion is that public health practitioners should not only be aware of the vulnerabilities or needs of the people in their areas of practice but also be familiar with their “clients” perspectives of their own worlds; that is, practitioners should consider a lifeworld led approach to their practice. Recently in the UK, Public Health England (PHE) has advocated that the “lived experience” of people in communities needs to be gleaned in order for health inequalities to be addressed effectively . This isInequalities in health are “Differences in the prevalence or incidence of health problems between individual people of higher and lower socio-economic status” . In the The latest Annual Health Report in Sweden  describeInequalities in health in the UK are widespread across the country and well established . In absoThere is a wider tradition of thought about how we act in our world and this paper suggests that there is a need for public health as a discipline to move outside the more mechanical or reductionist biological model of human meaning and behavior to address the complex issue of the reduction of inequalities in health . This maThe purpose of this paper is to introduce the practitioner to the concept of lifeworld and to allow its translation into practice. The authors acknowledge that there is a risk of over simplification of the philosophical background to this concept; however we feel it is important to share preliminary ideas about how this concept can be applied in practice. For this reason the authors have drawn on the contemporary work of Galvin and Todres  who haveThe “lifeworld” view has emerged from the work of philosophers such as Husserl , MerleauTemporality refers to time as experienced by human beings, for example, the rhythm of the seasons. As we as human beings adapt to the pressures of our time in a horological sense this can have a negative impact on our health and wellbeing and become an unmanageable pressure. This can limit our potential and prevent us from seeking out and experiencing new possibilities. Not having enough time or indeed having too much time to fill can be perceived as stressful and does indeed have a negative impact on our health. The recent report in the UK by the All-Party Parliamentary Group on Wellbeing Economics  cites evThe significance of the above in relation to temporality is that feelings of possibility relate to our temporal experience of the world. They can emerge through thoughts about personal histories and memories or indeed from our aspirations for the future . HoweverSpatiality refers to our human environmental context and our experience of living in that environment. The way we interact with our environment and the qualities of that environment can have a positive or negative impact on wellbeing . Our ownThrough intersubjectivity we make sense of our interpersonal world and others who share it. This intersubjectivity allows us to frame our thinking, our identity, and our relationships in time and space. For example, it can be reflected in our consideration of who we are close to, who we love, or who we want to be with. Intersubjectivity also helps us navigate our cultural and traditional contexts which impacts on our self-perception and how we view others . In termBeing human, we live within our bodies and experience the world through them . EmbodimWe would argue that low birth weight babies and obesity rates which are higher in low income groups in both the UK and Sweden , 4 refleThe lived experience is hugely influenced by mood which also helps shape the other dimensions of the lifeworld . It willIn relation to public health practice and the reduction of inequalities in health a lifeworld led approach enables insight into the potential negative impacts of ones circumstances in relation to mood and what factors impact on mood for that individual or family. This would help to plan appropriate support and interventions and would also give insight to local policy makers regarding how to offer support and developments which support mental health and wellbeing in an area.understand the person's lifeworld by listening to their view of their current situation and their potential, in relation toparticipation, occupation, engagement, and income ,the public health spatiality continuum ,safety and relationships (intersubjectivity),the context and potential for health behaviour change (embodiment),what factors may impact on mental health and wellbeing for a particular individual or family (mood);offer resources and empowerment based support as appropriate;share and lobby using lifeworld led case studies and enable community members to influence local and national policy and partnership working in relation to the individual, their family, and their local communities.This paper has outlined the elements of the lifeworld and their relevance for public health practice in relation to the reduction of health inequalities. There are some common principles which have emerged through the consideration of these elements in both the UK and Sweden which help to inform lifeworld led public health practice:


We show that a number of clinically relevant features of the invasive blood pressure are reproduced by the soliton model and examine the role of LV pulse energy on pulse wave shape and progression.The time profile of the arterial pulse is known to have features such as the dicrotic notch and subsidiary peaks. Such features may provide useful information about the vascular system and are traditionally explained in terms of aortic valve closure or multiple reflections from impedance mismatches within the arterial system. However, experimental evidence of such reflections has been elusive. It has been proposed that arterial dynamics may obey a nonlinear equation . This moA model for the arterial pressure is given by solutions to a KdV equation with constants depending on the properties of the artery . This caThe evolution of the arterial pulse along the arterial tree is shown in Figure Our simple model explains many features of the arterial pulse observed in clinical practice such as the development of the dicrotic notch, the change in shape along the arterial tree and the steepening and acceleration with hypertension. Some phenomena that have traditionally been attributed to arterial wave reflections or resonance of the invasive arterial pressure measurement can instead be explained by intrinsic properties of the arterial pulse.


High levels of occupational stress have been reported in podiatrists practising in Australia. One possible stressor is the predominance of the treatment of aged patients with chronic disease in Podiatry practice.Forty (40) Podiatrists attending a regional podiatry conference were invited to participate in the research using a convenience sampling method. Podiatrists were asked to complete a survey examining occupational stress in general and specifically in relation to practice with older adults (defined as those over the age of sixty five).The survey of sources of occupational stress among podiatrists has identified that patient demands and expectations are the most significant stressor both in general and in geriatric practice for the Podiatrist. The perceived limited clinical gains and chronic nature of their conditions in older patients was also ranked highly as a stressor.Working with the elderly is a significant part of podiatry practice and as such needs to be seen with more positive attitude by many practitioners. The development of geriatric practice as a speciality within the profession may help to raise the value of working with the elderly. This has implications for preparing podiatrists for practice with the geriatric population along with the need for strategies to avoid or minimise these work stressors.


There are many reasons why investigators decide to expend their energy on studying a particular nucleus in the brain. Sometimes the choice of structures has little to do with new insights that may be gleaned but is more attributable to the tractability of the site to experimental manipulation. However, some sites remain relatively obscure because their structure almost seems designed to impede research. The claustrum belongs to the latter group. Entombed between tightly constricting white matter bundles, the claustrum both escaped and resisted significant attention for much of the twentieth century. However, over the past decade there has been a resurgence in interest in the claustrum. This renewed attention is in large part attributable to a paper by Crick and Koch , which aThis collection of papers is an attempt to bring together many of the key recent findings on the claustrum. Perusing the volume quickly reveals that there is a striking emphasis on the anatomy of the claustrum, with most contributions emphasizing comparative anatomy of the claustrum, localization of different types of chemically-coded neurons within the claustrum, and new details on the morphology of claustral neurons. This selective attention to the anatomy of the claustrum has led some wags to comment that the anatomy of the claustrum should by now have been defined. However, striking differences in claustral organization and the anatomy of the region surrounding the claustrum across various species led to confusion regarding the boundaries of the claustrum. This resulted in some definitions being overly inclusive, adding to the claustrum several cortical regions that are now considered to be distinct. Other definitions were too restrictive and did not account for the ontogeny of the claustrum. This situation led Crick and Koch  to decryThis collection of papers appears to have arrived at a consensus regarding the definition of the claustrum, as seen from the vantage point of anatomical studies. Although there remain some small bones of contention, these are relatively minor and will no doubt soon be resolved. In light of the evolutionary expansion of the claustrum to its (discontinuous) presence in humans and other animals with large cortices, it is not surprising that about half of the manuscripts involve studies of primates  to undertake longitudinal studies of claustrum volume in health and disease, and with co-registration algorithms it may be possible to differentiate the contribution of the claustrum and insular cortex to fMRI signal changes. Finally, advances in methods for producing knockout and transgenic animals, such as that afforded by CRISPR/cas approaches, has made the rapid generation of such animals possible, opening the door to behavioral studies of claustral function.As noted earlier, the claustrum's peculiar shape has historically been a major impediment to functional studies of the claustrum. Fortunately, the advent of new methods and improvements in existing methods has made it possible to probe claustral function at the molecular, physiological, and behavioral levels. One can now study the physiology of the claustrum using optogenetic or chemogenetic approaches in slice preparations and Over the decade since the publication of Crick and Koch's cry for molecular studies of the claustrum and their hypothesis on claustral involvement in binding of percepts, a consensus regarding claustral structure has been reached. Over the next decade we look forward to a comparable blossoming of functional studies that unlock the deep secrets of the claustrum.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Mathematical modeling can serve to inform strategies for malaria eradication from different levels of scale depending on the needs of the strategy and the granularity of the data available to create the models. At the most granular level of data, estimates of individual dose-effect relationships for anti-malarial drugs and vaccines can be used to simulate the impact of different implementation strategies for administration and estimate the resulting impact of the therapeutic on disease treatment and transmission reduction. Coupled with epidemiological models that simulate the overall impact on disease prevalence across broad geometries, these tools can become important in planning at a regional level the appropriate response to eradicating malaria. Simplifying assumptions that make the modeling tractable can also limit its usefulness however, as understanding not only the human transmission aspect of the disease but also the vector transfer, the role of underlying geography and weather on vector movement, and the interactions of humans across space and time is important for realistic estimates of strategy impact through modeling. An iterative approach is needed where models predict the impact of an approach, the approach is attempted, the results are fed back to update the model in an iterative way, and new estimates are produced. Through this effort, models of malaria eradication can be important tools in guiding disease eradication.


We would like to respond to the eye-opener by Walsh , in whicvulnerability and undue influence. According to the Declaration of Helsinki [Concerning the first threat, we think it is important to distinguish between Helsinki , vulneraHelsinki .Concerning the second threat, we recognize the problematic overrepresentation of undergraduate students in research mentioned by Walsh. Yet oversight by ethics committees will not be sufficient to address this problem as they simply lack the required oversight and the means to influence research agendas. Instead of calling for oversight we suggest that persons that are invited to participate in research must be selected for scientific reasons and not because they are easy to recruit. In addition researchers should justify to a research ethics committee the exclusion of other groups. Equity indeed requires that the benefits of research be distributed fairly and that no group or class of persons bear more than its fair share of the risks or burdens from research participation.All authors are board members of the Netherlands Association for Medical Education (NVMO) Ethical Review Board.


The benefits of deep brain stimulation for parkinsonian patients are well documented and have established the method as mainstay in the late stages of the disease . Such concerns also appear quite regularly in patient support group meetings. My impression is, that patients and their representatives feel their concerns not appropriately reflected in the scientific literature and expert opinions. This comment responds to such observations with the aim to reposition the defense of DBS for Parkinson's disease. Reluctance to delve into this subject may in my opinion eventually leave those who offer the procedure defenseless toward reproach from patients, referring colleagues and the general public.One may counter such observations by outlining that, particularly in case of complex psychiatric side effects, there are no objective means of deciding when a treatment has to be considered a failure or a success. Patients and relatives have also the propensity to underestimate their preoperative disabilities  may be content or even happy with the result, the patient's family may be dismayed about disinhibited and reckless behavior.After some weeks hypomania may subside but other alterations in mood and behavior surface. Depression and Apathy may evolve and stay for years leading to markedly reduced quality of life not only for the patient but also for his caregivers. The reasons for both remain unclear and have been attributed to the stimulation directly or the resulting changes in medication. The incidence of both is relatively well reflected in the scientific literature  the issues with the most confounding ethical impact. While hypomania subsides and depression may respond to treatment, rarely measurements are taken to exclude less obvious changes in behavior and personality. Fundamental changes in personality have been relatively seldom been studied (Florin et al., Changes in personality or moral competences have so far not been an issue in recent large studies (Schuepbach et al., One reason for the frequency of psychiatric side effects may be the stimulated target. As the standard target for DBS in Parkinson disease the STN must be foremost scrutinized.One of the basic assumptions in defense of the safety of the STN is the assumption that it consists of three clearly separated parts and that electrodes can be reliably steered into the motor part that exclusively contains motor functions. This concept while propagated by some researchers (Temel et al., Empirically the majority of studies come to the conclusion that targeting the GPI produces less psychiatric side effects (Liu et al., The evaluation search for alternative targets should therefore be continued. Other promising targets are located in the subthalamic space within the fiber connections between thalamus cerebellum and basal ganglia as proposed by Velasco and others. However, it must been kept in mind that the basal ganglia and the cerebellum are involved in the processing of cognitive and emotional tasks and with the effects of stimulation spreading far complete avoidance of mental side effects is therefore not possible.In summary, the available evidence suggests to my understanding that neuropsychiatric effects may be an integral albeit unintended effect of DBS for Parkinson's diseases. The ethical issues related to these effects may be even less trivial compared with DBS for psychiatric disorders. In the latter case, DBS is used with a transparent and obvious intention to interfere with the patient's psyche (Chabardes et al., Subsequently a sober and unprejudiced discussion about how far these phenomena can be accepted should evolve. For fear of putting a well-established and beneficial procedure at peril, its disadvantages shall not be disguised.The discussion about target points that carry a lower risk of changing the patient's personality should continue. Patients must be informed about the available targets and the risks and benefits connected with each of them.Prerequisite for the future development of DBS are diagnostic tools that are reliably able to detect the long-term consequences of the operation on behavior, personality and moral competence. Suitable scales can be developed or integrated from other disciplines into the clinical assessment and future studies. These must concentrate on the crucial domains of social interaction and judgment of own behavior. They should also address caregivers and family's perception of the patient and the impact on their life.- The existence of psychiatric side effects as integral part of the treatment should be conceded.- It should be asserted that DBS is a reversible therapy and can therefore not be put on a par with irreversible surgical interventions like the lesioning of brain areas. In analogy to drug therapy it can be discontinued simply by switching it off.- The patient should be fully informed about the intrinsic risks of psychiatric adverse events, possible changes of personality and the targets at hand. Ideally the patient's partners and next of kin are involved and informed about the possible resulting burden as caregivers. This will counter the reproach of guiding patients into a treatment with consequences he cannot foresee.In defense of the procedure a reversal in the argumentation should be considered:Clearly the issue of psychiatric side effects of DBS involves a legally and ethically utterly sophisticated discussion. Yet postponing it beyond the moment the lay press may cover negative events in an untoward manner will not improve our position to influence its already unforeseeable outcome.The author confirms being the sole contributor of this work and approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author has received grants for contributing to the development of stereotactic planning systems from Medtronic and Precisis.


Publication audit is considered a useful tool to evaluate the progress and plan for the future and we have been doing this exercise for the last couple of years.As regards submissions from Pakistan as expected most of the submissions were from Karachi 97 Lahore 40, Hyderabad and Peshawar 21 each while submissions from Islamabad and Rawalpindi were 18 and 17 respectively. A vast majority of the published manuscripts during 2014 included original articles 248 followed by case reports 20 and Review articles ten. The number of submissions increased to 1577 in 2014 from 1023 in 2012 and 1091 in the Year 2013. Most of the submissions during 2012 and 2013 were also from Pakistan, Iran, Turkey and China and this has seen a continuous increase in the number of submissions from these countries over the years. It not only shows the popularity of the Pakistan Journal of Medical Sciences in these countries but also reflects that the authors are also satisfied with the processing and peer review system practiced by us. The biggest increase in submissions was witnessed from Peoples Republic of China starting from 189 in the Year 2012 to 325 in 2013 and 524 in the Year 2014. However, after pee review only 34 manuscripts from China were published during the Year 2012 and it increased to eighty in 2013 and eighty nine in the Year 2014. According to reports, China is the second biggest contributor to medical literature after United States of America which shows the tremendous research work being done by the Chinese research scientists and the recognition of research accomplishments by the Chinese Government. Similarly the number of manuscripts published from Turkey increased from thirty seven in 2012 to thirty eight in 2013 and eighty nine in 2014. The number of manuscripts accepted for publication after peer review from Saudi Arabia has also increased from sixteen in 2012 to seventeen in 2013 to nineteen in 2014. Kingdom of Saudi Arabia has also made lot of investment in the health sector and has established many new medical schools and tertiary healthcare facilities and the researcher’s contribution to medical literature is recognized and appreciated while making selection and academic promotions which has resulted in promotion of research culture in the Kingdom.However, the number of submissions and manuscripts published after peer review from Islamic Republic of Iran has been constantly decreasing over the years. The number of published manuscripts from Iran in 2012 was sixty three which slightly increased in 2013 to seventy but decreased in the Year 2014 to just fourteen. It is because of the fact that now we are very selective and the authors from Iran are encouraged to publish their research work in their own biomedical journals. The number of medical journals published from Iran has increased from ninety in 2004 to 437 in 2014. Hence, the authors from Iran also find it more convenient to publish their research work in their own journals while it also saves them the publication charges since most of the journals published from Iran are run and managed by the medical universities and most of them do not charge any publication fee.In view of the past experience and the reported developments we are now also very selective as regards accepting case reports, Reviews and Meta Analysis. Only very rare case reports are accepted while Reviews and Meta analysis also remains a very low priority with us and the authors are advised to get it published in their own country. Another reason for decreased submissions and publication of manuscripts from Iran is that many of the manuscripts which include KAP studies, Surveys, routine me too studies or those which just have local relevance are not accepted for further processing and the authors are advised to submit it to their local journals.On the whole, over the years we are quite satisfied with the progress which we have made and now as per Scopus the well known international database, Pakistan Journal of Medical Sciences is included in the top Ten Biomedical Journals published from the Eastern Mediterranean Region. The other three medical journals from Pakistan included in this list are Journal of College of Physicians and Surgeons Pakistan (JCPSP), Journal of Pakistan Medical Association (JPMA) and Journal of Ayub Medical College, Abbottabad. (JAMC).


To the Editor: We wish to clarify an inaccuracy in a letter in Emerging Infectious Diseases by Cao-Lormeau et al. (Although dengue was initially part of the differential diagnosis, and a few patients had evidence of IgM against dengue virus by a rapid diagnostic test, clinicians in Yap believed that the clinical syndrome was not consistent with dengue. Thus, assistance was requested from the US Centers for Disease Control and Prevention and the World Health Organization to strengthen the epidemiologic investigation and provide confirmatory laboratory testing.Serum samples collected during the active investigation were sent to the Arboviral Diseases Diagnostic Laboratory at the Centers for Disease Control and Prevention where testing determined that the cause of the infections was ZIKV (


The Acknowledgment Section in the original publication was incomplete. The full acknowledgment is:The research was funded by National Science Foundation grant BCS-0849034 awarded to principal investigator Dr. Boaz Keysar, who also provided guidance in this project. We would like to thank Chloe Goldman for helping with running the studies and Sayuri Hayakawa for helpful comments on an earlier version of the manuscript.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Since the US Congress designated the 1990s as the “Decade of the Brain,” much of the research in psychiatry has endeavored to explain psychiatric disorders in terms of interconnected sets of dysfunctional neural circuits. The shift in focus from behavioral manifestations to the underlying neurobiology of mental illness has driven the field of biological psychiatry in general and the Research Domain Criteria (RDoC) in particular. The aim of the RDoC is to identify brain mechanisms that can explain the etiology and pathophysiology of psychiatric disorders, provide earlier and more accurate diagnosis, and predict treatment responses and outcomes  and light in optogenetics to activate or inhibit neural activity , for example, can be described as conditions in which the representation of a disturbing or traumatic memory of an event persists in the brain to the point of becoming maladaptive or pathological (Schacter, The neural circuits on which the RDoC focuses may not adequately consider the effects of neuro-immune and neuro-endocrine interactions in the pathophysiology of depression, schizophrenia and possibly other disorders. Cytokines released in response to infection may result in elevated levels of inflammatory biomarkers in the blood. These in turn may lead to inflammatory changes in the brain and alteration of neural circuits that could trigger or exacerbate mood disturbances and cognitive and volitional impairment in depression (Raison et al., Psychiatric disorders result from interaction among neurons, genes, immune and endocrine systems and the affected person's psychological response to the natural and social environment. Explaining these disorders at a brain-systems level is necessary but not sufficient to understand how they develop and how they can be treated with pharmacological and behavioral therapies targeted to individuals affected by them. Ordered and disordered states of brain and mind are influenced by factors both inside and outside of the brain. Mental illness currently constitutes 7.4% of the global burden of disease, and its incidence will increase exponentially in the future (Becker and Kleinman, The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The changing face of healthcare commissioning within England provided Infection Prevention Specialists with an opportunity to embed Infection Prevention and Control (IPC) into the heart of contractual arrangements. The Infection Prevention Society (IPS) collaborated with the Royal College of Nursing (RCN) to help support members in meeting the challenge of ensuring this key element to achieve quality and safety is embedded in the emerging commissioning landscapeThis paper will outline the work of the Commissioning Network in influencing IPC commissioning.A joint scoping day was with members of the IPS and RCN to gain an understanding of the implications to commissioning in IPC. Agreed outcomes included the immediate release of a joint position statement to inform external stakeholders of the value of commissioning for IPC and plans for the development of assurance framework and key IPC indicators. As emerging guidance regarding the NHS commissioning landscape came to the fore, in 2011, priority was given to the development of additional tools to support and inform members, these included an option appraisal and mapping documents, both of which outlined the function and future form of IPC in the new commissioning organisations. Following further consultation with members, the network produced the first IPC Commissioning Toolkit in March 2013 and this has been updated in March 2015. The toolkit provided commissioners with a set of IPC indicators for use in healthcare contracts. Additional resources have also been developed including two briefing paper documents which aimed to highlight the challenges regarding the changes within the new commissioning system and the potential impact on commissioning safe services with respect to IPC. These documents were released prior to the implementation of the changes in October 2013 and it was revised following the changes in March 2015.The evaluation of the resources was positive, many alluded to the usefulness of the documents during a challenging period of uncertainty and used them to inform local decisions. There was also evidence that the toolkit had been used by commissioners and also providers in determining key performance indicators for IPC.Following the positive evaluation of the commissioning toolkit, there are plans to develop a third edition which will encompass various health care settings and social care.None declared.


The Research Domain Criteria (RDoC) project was initiated by the NIMH as a way of explaining and understanding the etiology and pathophysiology of psychiatric disorders at a brain-systems level  axis (Hohne et al., Nor do mechanistic explanations adequately account for the epigenetics of depression. They do not consider how environmental exposures can alter chromatin structure in gene expression in determining the lifetime risk of depression or its severity in those who develop it Nestler, . DynamicThe success of the RDoC in psychiatry will not depend on the theoretical issue of whether it allows for the collective stabilization of valid constructs for conceptual and explanatory integration. Specifically, it will not depend on mechanistic explanations. Rather, it will depend on the combined theoretical and practical issue of whether investigation of neural circuits and networks results in more accurate diagnosis, prognosis and more effective therapies for, and ideally prevention of, diseases of the brain-mind. This would enable the RDoC to achieve or at least approximate the goal of reducing the global burden of these diseases and improving quality of life for the millions of people who suffer from them. Sullivan's proposed stabilizing project may improve the RDoC as a conceptual model for cognitive neuroscience. Yet while the RDoC considers environmental and other factors outside the brain among its domains and is not strictly reductive, it does not adequately appreciate the degree to which psychosocial factors in particular contribute to psychiatric disorders. It is an incomplete model for explaining them. This requires a more comprehensive model that includes the full extent of interaction between and among the central nervous and other bodily systems, and especially interaction between the person constituted by these systems and the environment. To reduce the magnitude of harm from mental illness, psychiatrists need to focus not just on neural parts and the integrated neural functions in which they are realized but also on the whole neurobiological-psychological-environmental context in which people are affected by it.The author confirms being the sole contributor of this work and approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The Paediatric Unit at Flinders Medical Centre in South Australia launched an Eating Disorder Program in February 2013. The presentation of an eating disorder patient varies among consumers, and treatment requires a sustained, flexible and multidisciplinary approach. Physiotherapy was asked to be involved in the multi-disciplinary team to deliver an inpatient exercise class to provide education on posture and provide a safe environment for healthy exercise. The class began and consisted of two half an hour sessions a week. To increase the knowledge of Physiotherapy management in Eating Disorders a study tour was undertaken to observe the role of physiotherapists at the leading children's hospitals. The hospitals visited include Westmead Children's Hospital, Princess Margaret Hospital and the Starship Children's Hospital in Auckland. On completion of the study tour it was identified that to progress Physiotherapy involvement with the Eating Disorder population we should incorporate an initial physiotherapy assessment when new patients are admitted, provide discharge information for exercise and an information sheet for parents for compulsive exercise. It was also identified that there were no guidelines for Physiotherapy Management in Eating Disorders and this would be beneficial to standardise the role of physiotherapy across Australia.


There is an omission in the Acknowledgements section. The correct Acknowledgments statement is as follows: We would like to thank all members in our local sites for their support and collaboration. We are highly grateful to the Dengue Vaccine Initiative (DVI) team and would like to acknowledge the excellent team work. The International Vaccine Institute (IVI) also acknowledges the Governments of the Republic of Korea and Sweden for their core support to IVI.