http://bura.brunel.ac.uk/handle/2438/25436 2026-04-15T22:10:56Z http://bura.brunel.ac.uk/handle/2438/33142 Title: Triple Burden in the Democratic Republic of Congo: Climate Change, Armed Conflict, and the Silent Spread of Arboviruses. A Narrative Review Authors: Donnang, S; Yokolo, H; Makeda, D; Ekouo, J; Shams, Z; Kaptso, JAD; Kamgang, JS; Waffo, YV; Tague, C Abstract: Background: The Democratic Republic of Congo (DRC) faces a “triple burden” of public health threats which includes climate change, protracted armed conflict, and the under-recognized spread of arboviral diseases. Arboviruses, such as dengue, chikungunya, Zika, and yellow fever, are transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Certain factors, like environmental changes, population displacement, and inadequate vector control, have created conditions that favor sustained transmission. Methods: The narrative review was conducted to compile evidence on factors influencing arbovirus spread in the DRC and to identify the priority causes of prevention. A comprehensive literature search was done in PubMed and Google Scholar for studies, NGO reports, and government documents published between 2019 and 2025 in French or English, focusing on human populations in the DRC or similar contexts. Results: Key findings demonstrate that yellow fever remains endemic, with recurrent outbreaks and a case fatality rate of up to 21.3% in past years. Seroprevalence studies show significant dengue exposure (up to 41% in Kinshasa), multiple chikungunya epidemics which affected millions, and intermittent Zika virus exposure. On the other hand, adverse climate change alters vector ecology and increases transmission potential through drought, floods, rising temperatures, and deforestation. Armed conflict proved to play a major role in the large-scale displacement of people into overcrowded, unsanitary environments. This, as a result, disrupts the surveillance and control programmes and increases vulnerability to arboviruses. Conclusion: The convergence of climate change, armed conflict, and arbovirus transmission poses a growing public health threat in the DRC. Strengthening integrated and reinforced surveillance, augmenting diagnostic capacity, applying sustainable vector control, and advocating climate and security considerations in health policy are essential and mandatory. Without coordinated and multidisciplinary action, the silent and hazardous spread of arboviruses will remain consistent to weaken and compromise health system resilience. Summary: • The Democratic Republic of Congo (DRC) confronts a triple health crisis facilitated by adverse climate change, ongoing armed conflict, and emerging arboviral infections. • Climate change in the DRC is speeding up vector proliferation and extending transmission seasons, which in turn expands arbovirus-endemic zones. • Ongoing armed conflict causes disruption in healthcare delivery and displacement of populations, increasing extreme vulnerability to infectious disease outbreaks. • Arboviruses such as dengue, Zika, yellow fever, and chikungunya are often underdiagnosed due to limited laboratory capacity and overlap of symptomatic manifestations with malaria. • In addition, climate-driven ecological and epidemiological shifts establish ideal conditions for silent arbovirus spread and contribute to risk for the human population. • These problems can be eradicated by coordinated surveillance, aggressive vector control, and humanitarian-health integration, which are essential to break the cycle of vulnerability and unsafe situations. Description: Data Availability Statement: The authors have nothing to report. 2026-03-29T00:00:00Z http://bura.brunel.ac.uk/handle/2438/33132 Title: Exploring equity and inclusion in team-based learning: A critical pedagogy perspective Authors: Anas, S; Selway, J; Otermans, P Abstract: Background: Team-Based Learning (TBL) is widely used in medical education to promote active engagement, yet its structured format raises questions about how power, voice, and cultural inclusion are negotiated. Using a critical pedagogy lens can illuminate how students experience these dynamics. Methods: This mixed-methods study explored Year 2 international medical students’ experiences of inclusion, participation, and cultural responsiveness within a TBL-based curriculum. Forty-two students completed a 13-item survey, analysed descriptively, and 11 students participated in focus groups, analysed thematically. Results: Students valued TBL for fostering collaboration, critical thinking, and respectful peer dialogue. They also acknowledged the exposure to diverse perspectives in the TBL classroom and valued the agency to challenge and critique content peers and their educators. Educators were not consistently perceived as embedding culturally diverse examples and some students experienced participation barriers linked to language and accent. Conclusion: The TBL classroom embodied many aspects of critical pedagogy in practice; structures which promoted learner engagement through a dialogic process and reimagining the role of the educator as a facilitator for critical learning. However, while TBL offers a supportive structure for peer learning, inclusive and culturally responsive outcomes are not guaranteed. These depend on educator facilitation and intentional design that centres equity and critical dialogue. In order to achieve the emancipatory education envisioned by Freire, educators and institutions must commit to critical reflection, create safe dialogic spaces that value all learners’ voices, and intentionally disrupt power imbalances embedded in learning environments. Description: Supplemental material is available online at: https://www.tandfonline.com/doi/full/10.1080/0142159X.2026.2649941# . 2026-04-01T00:00:00Z http://bura.brunel.ac.uk/handle/2438/33074 Title: The ExtRA Capacity Test: Reliability, validity and normative data of a new clinical tool for assessing shoulder muscle performance Authors: Ford, H; Lewis, J; Tyros, V; Low, DC; Bateman, WR; Lee, Y; Sakadasariya, R; Rex, J; Oldfield, M; Davare, M; Shaheen, AF Abstract: Objectives: Introduce The ExtRA Capacity Test, a measure for assessing shoulder muscle performance. Assess its reliability, validity and present normative scores in a large sample of asymptomatic adults. Design: Cross-sectional observational study with test–retest. Setting: Community. Participants: Volunteers (n = 344, age 20–90 years). Interventions: The ExtRA Capacity Test involves two capacity tests completed to a 30 beats per minute metronome: maximal scapular plane lateral raises to 90° abduction with 2.5 kg of external load, and maximal external rotations in unsupported prone lying with the shoulder at 90° abduction. Reliability was assessed in 30 asymptomatic participants, tested by two raters over two sessions, one week apart, using Bland–Altman analysis to determine mean bias and 95 % limits of agreement (LoA) as measures of error. Criterion validity was evaluated in 20 participants using Pearson correlation to examine the relationship between ExtRA and isokinetic dynamometry measures. A normative dataset was also established from 344 asymptomatic individuals across a range of ages, physical activity levels, and both sexes. Results: The intra-rater and inter-rater agreement for the ExtRA Capacity Test was assessed in a sample of 30 participants. The 95 % LoA for abduction and external rotation measurements ranged from 2.9 to 13.1 repetitions. In a sample of 20 participants, the abduction test showed good/moderate correlation with muscle strength measures but not with the external rotation test. Older age, female sex and not achieving the WHO activity guidelines have a negative impact on ExtRA performance. Conclusions: Within the caveats discussed in this paper, ExtRA can be considered a reasonably reliable tool for assessing shoulder strength and control in a clinical setting. The normative database will help clinicians set rehabilitation or return-to-play targets based on sex, age, and physical activity level. Contributions of Paper: • This study introduces the ExtRA Capacity Test as a reliable tool for assessing shoulder muscle performance in both sporting and non-sporting populations. • The test demonstrates clinically acceptable intra- and inter-rater reliability, with the abduction component showing a strong correlation with strength measures from Isokinetic Dynamometry. • The normative database established in this study facilitates the evaluation of shoulder performance relative to reference values stratified by age, sex, and physical activity level. • Given its high reliability, the ExtRA Capacity Test can be used to monitor performance changes over time, providing valuable insights for clinical practice and rehabilitation planning. Description: Supplementary material: Supplementary data associated with this article can be found in the online version at: https://www.sciencedirect.com/science/article/pii/S0031940625004067?via%3Dihub#sec0105 . 2025-12-11T00:00:00Z http://bura.brunel.ac.uk/handle/2438/32556 Title: A global overview of anatomical science education and its present and future role in biomedical curricula Authors: Hortsch, M; Carneiro Girão-Carmona, VC; Rocha de Melo Leite, AC; Nikas, IP; Gatumu, MK; Koney-Kwaku Koney, N; Arko-Boham, B; Yohannan, DG; Oommen, AM; Li, Y; Yang, J; Trollope, AF; Meyer, AJ; Van Nuland, SE Abstract: The four main anatomical sciences, gross anatomy, histology, neuroanatomy, and embryology, are fundamental subjects for most health professionals and biomedical students. Usually taught as part of preclinical basic science training, the anatomical sciences provide a structural understanding of human or animal bodies at both macroscopic and microscopic levels. This overview characterizes how the anatomical sciences are currently taught around the globe, highlighting similarities, differences, and recent curricular transformations that were partially in response to the COVID-19 pandemic. Globally, educators of the anatomical sciences navigate similar pressures, including expectations of curricular integration and reduced time for anatomical teaching. Student-centered teaching approaches and e-learning technologies have been adopted across many regions, transforming how educators engage their learners. However, not all educators are provided with technological resources to facilitate such educational advancements, particularly in regions where economic inequality and poor infrastructure hinder access to the internet. Though ethical standards guiding the procurement of human bodies have evolved over time, the sources of human bodies that academic institutions use for anatomy education vary widely. Specific regional issues complicate many aspects of anatomical science education, challenging educators to adopt novel teaching approaches. Despite some differences, every global region appears to be moving in a similar direction. However, where academic institutions fall on that trajectory differs for specific regions/countries. How these educational and technological changes influence anatomy education should be carefully considered for the strengths and weaknesses they provide and the opportunities and threats they bring.; Graphical Abstract: How the anatomical sciences are taught worldwide is constantly changing. Common themes are a reduction of teaching time and the inclusion of e-learning and new pedagogical approaches. Although there is a common direction of change, where different global regions place along that trajectory often correlates with their economic status. 2025-10-21T00:00:00Z