New perspectives - approaches to medical education at four new UK Medical Schools

To create more UK doctors, the government has funded an increase in medical student numbers of 57% (from 3749 to 5894)1 between 1998 and 2005. This has been done by increasing student places at existing medical schools; creating shortened programmes open to science graduates; “twinning” arrangements, which host an existing curriculum at a new site; and four entirely new schools (table 1). Through reflection on our experiences and the literature evidence, we examine to what extent these new schools have a common vision and approach to undergraduate medical education, and we discuss the rationale for and likely outcomes of these new ventures

A serological investigation of caseous lymphadenitis in four flocks of sheep

A double antibody sandwich ELISA developed by ID-DLO, Lelystad to detect Corynebocterium pseudotuberculosis infection was used on 329 sheep from four pedigree Suffolk flocks in which clinical cases of caseous lymphadenitis (CLA) had occurred. At subsequent necropsy, typical CLA lesions were seen in 133 sheep, and the diagnosis was confirmed on culture. Lesions were most commonly seen in lungs (n = 46), parotid lymph nodes (n = 44), prescapular lymph nodes (n = 38) and mediastinal lymph nodes (n = 31). The sensitivity of the ELISA test for detecting culture-positive sheep was 0.88, while the specificity of the test was 0.55. The antibody ELISA detected 87.5 per cent of sheep that had CLA lesions restricted to internal organs only. It was concluded that the ELISA test has a valuable role in detecting sheep with both clinical and subclinical CLA

Qualitative Case Studies in Operations Management: Trends, Research Outcomes, And Future Research Implications

Our study examines the state of qualitative case studies in operations management. Five main operations management journals are included for their impact on the field. They are in alphabetical order: Decision Sciences, International Journal of Operations and Production Management, Journal of Operations Management, Management Science, and Production and Operations Management. The qualitative case studies chosen were published between 1992 and 2007. With an increasing trend toward using more qualitative case studies, there have been meaningful and significant contributions to the field of operations management, especially in the area of theory building. However, in many of the qualitative case studies we reviewed, sufficient details in research design, data collection, and data analysis were missing. For instance, there are studies that do not offer sampling logic or a description of the analysis through which research out-comes are drawn. Further, research protocols for doing inductive case studies are much better developed compared to the research protocols for doing deductive case studies. Consequently, there is a lack of consistency in the way the case method has been applied. As qualitative researchers, we offer suggestions on how we can improve on what we have done and elevate the level of rigor and consistency

What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews

OBJECTIVES: To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE). DESIGN: Interrupted time series analysis, review of case notes, survey, and interviews. SETTING: Acute and primary care trusts in England and Wales. PARTICIPANTS: All primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from five acute trusts. MAIN OUTCOME MEASURES: Rates of prescribing and use of procedures and medical devices relative to evidence based guidance. RESULTS: 6308 usable patient audit forms were returned. Implementation of NICE guidance varied by trust and by topic. Prescribing of some taxanes for cancer (P <0.002) and orlistat for obesity (P <0.001) significantly increased in line with guidance. Prescribing of drugs for Alzheimer’s disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance. Prescribing practice often did not accord with the details of the guidance. No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued. CONCLUSIONS: Implementation of NICE guidance has been variable. Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated. Guidance needs to be clear and reflect the clinical context

The 3D nature of a real un-dismantled electrical contact interface

AbstractA 3D contact analysis and modeling suite of tools are developed and introduced in this work. The “3D Contact Map” of an electrical contact interface is presented demonstrating the 3D nature of the contact. It gives information on where the electrical contact spots in a 3D surface profile are located. An X-ray Computer Tomography (CT) technique is used to collect the 3D data to a resolution of around 5μm of a real un-dismantled contact interface for analysis. Previous work by Lalechos and Swingler presented “2D Contact Map” on a 2D contact profile from collected 3D data to a resolution of around 8μm. The main advantages of both 3D and 2D mapping techniques focus on the fact that they are non-destructive and there is no need to dismantle the component of interest. This current work focuses on the 3D mapping technique showing its advantages over the 2D mapping technique. For test purposes, a 16A rated AC single pole switch is scanned after two different current loading tests (0A and 16A). A comparison for the total mechanical area of contact, the number of contact spots and the total contact resistance is conducted using both the 2D and 3D mapping techniques to a resolution of around 5μm

National Institute for Clinical Excellence and its value judgments

The National Institute for Clinical Excellence (NICE) offers health professionals in England and Wales advice on providing NHS patients with the highest attainable standards of care. NICE gives guidance on individual health technologies, the management of specific conditions, and the safety and efficacy of interventional diagnostic and therapeutic procedures. Guidance is based on the best available evidence. The evidence may not, however, be very good and is rarely complete. Those responsible for formulating the NICE’s advice therefore have to make judgments both about what is good and bad in the available science (scientific value judgments) and about what is good for society (social value judgments). In this article we focus on the scientific and social judgments forming the crux of the institute’s assessment of cost effectiveness. Scientific value judgments and those relating to clinical effectiveness are considered elsewhere

Evaluation of ASTER GDEM ver2 using GPS measurements and SRTM ver4.1 in China

The freely available ASTER GDEM ver2 was released by NASA and METI on October 17, 2011. As one of the most complete high resolution digital topographic data sets of the world to date, the ASTER GDEM covers land surfaces between 83°N and 83°S at a spatial resolution of 1 arc-second and will be a useful product for many applications, such as relief analysis, hydrological studies and radar interferometry. The stated improvements in the second version of ASTER GDEM benefit from finer horizontal resolution, offset adjustment and water body detection in addition to new observed ASTER scenes. This study investigates the absolute vertical accuracy of the ASTER GDEM ver2 at five study sites in China using ground control points (GCPs) from high accuracy GPS benchmarks, and also using a DEM-to-DEM comparison with the Consultative Group for International Agriculture Research Consortium for Spatial Information (CGIAR-CSI) SRTM DEM (Version 4.1). And then, the results are separated into GlobCover land cover classes to derive the spatial pattern of error. It is demonstrated that the RMSE (19m) and mean (-13m) values of ASTER GDEM ver2 against GPS-GCPs in the five study areas is lower than its first version ASTER GDEM ver1 (26m and -21m) as a result of the adjustment of the elevation offsets in the new version. It should be noted that the five study areas in this study are representative in terms of terrain types and land covers in China, and even for most of mid-latitude zones. It is believed that the ASTER GDEM offers a major alternative in accessibility to high quality elevation data

Revisiting protein aggregation as pathogenic in sporadic Parkinson and Alzheimer diseases.

The gold standard for a definitive diagnosis of Parkinson disease (PD) is the pathologic finding of aggregated α-synuclein into Lewy bodies and for Alzheimer disease (AD) aggregated amyloid into plaques and hyperphosphorylated tau into tangles. Implicit in this clinicopathologic-based nosology is the assumption that pathologic protein aggregation at autopsy reflects pathogenesis at disease onset. While these aggregates may in exceptional cases be on a causal pathway in humans (e.g., aggregated α-synuclein in SNCA gene multiplication or aggregated β-amyloid in APP mutations), their near universality at postmortem in sporadic PD and AD suggests they may alternatively represent common outcomes from upstream mechanisms or compensatory responses to cellular stress in order to delay cell death. These 3 conceptual frameworks of protein aggregation (pathogenic, epiphenomenon, protective) are difficult to resolve because of the inability to probe brain tissue in real time. Whereas animal models, in which neither PD nor AD occur in natural states, consistently support a pathogenic role of protein aggregation, indirect evidence from human studies does not. We hypothesize that (1) current biomarkers of protein aggregates may be relevant to common pathology but not to subgroup pathogenesis and (2) disease-modifying treatments targeting oligomers or fibrils might be futile or deleterious because these proteins are epiphenomena or protective in the human brain under molecular stress. Future precision medicine efforts for molecular targeting of neurodegenerative diseases may require analyses not anchored on current clinicopathologic criteria but instead on biological signals generated from large deeply phenotyped aging populations or from smaller but well-defined genetic-molecular cohorts

Fuzzy-logic-based control, filtering, and fault detection for networked systems: A Survey

This paper is concerned with the overview of the recent progress in fuzzy-logic-based filtering, control, and fault detection problems. First, the network technologies are introduced, the networked control systems are categorized from the aspects of fieldbuses and industrial Ethernets, the necessity of utilizing the fuzzy logic is justified, and the network-induced phenomena are discussed. Then, the fuzzy logic control strategies are reviewed in great detail. Special attention is given to the thorough examination on the latest results for fuzzy PID control, fuzzy adaptive control, and fuzzy tracking control problems. Furthermore, recent advances on the fuzzy-logic-based filtering and fault detection problems are reviewed. Finally, conclusions are given and some possible future research directions are pointed out, for example, topics on two-dimensional networked systems, wireless networked control systems, Quality-of-Service (QoS) of networked systems, and fuzzy access control in open networked systems.This work was supported in part by the National Natural Science Foundation of China under Grants 61329301, 61374039, 61473163, and 61374127, the Hujiang Foundation of China under Grants C14002 andD15009, the Engineering and Physical Sciences Research Council (EPSRC) of the UK, the Royal Society of the UK, and the Alexander von Humboldt Foundation of Germany