Integration of computer technology into the medical curriculum: The King's experience

King's College London has developed a new curriculum which prepares students to deliver a high‐quality clinical service. A variety of active‐learning techniques are utilized to produce a deep approach to learning with an emphasis on vocational needs in the domains of knowledge, attitudes and skills. Integration of academic and clinical studies, as recommended by the General Medical Council (GMC), poses a number of difficulties, particularly in terms of communication between disparate geographical sites. The new curriculum aims to take advantage of computer technology to supplement and enhance traditional methods of learning and to ensure that students are competent in a defined range of skills. To aid integration, all students joining the new course are offered notebook computers and enhanced access to desktop computers, both with facilities to link to the main network This allows students to use multimedia material incorporated into the new curriculum and to access online services from remote locations. This paper reviews the integration of such computer technology into the new medical curriculum at King's

Forensic science evidence in question

How should forensic scientists and other expert witnesses present their evidence in court? What kinds and quality of data can experts properly draw on in formulating their conclusions? In an important recent decision in R. v T1 the Court of Appeal revisited these perennial questions, with the complicating twist that the evidence in question incorporated quantified probabilities, not all of which were based on statistical data. Recalling the sceptical tenor of previous judgments addressing the role of probability in the evaluation of scientific evidence,2 the Court of Appeal in R. v T condemned the expert’s methodology and served notice that it should not be repeated in future, a ruling which rapidly reverberated around the forensic science community causing consternation, and even dismay, amongst many seasoned practitioners.3 At such moments of perceived crisis it is essential to retain a sense of perspective. There is, in fact, much to welcome in the Court of Appeal’s judgment in R. v T, starting with the court’s commendable determination to subject the quality of expert evidence adduced in criminal litigation to searching scrutiny. English courts have not consistently risen to this challenge, sometimes accepting rather too easily the validity of questionable scientific techniques.4 However, the Court of Appeal’s reasoning in R. v T is not always easy to follow, and there are certain passages in the judgment which, taken out of context, might even appear to confirm forensic scientists’ worst fears. This article offers a constructive reading of R. v T, emphasising its positive features whilst rejecting interpretations which threaten, despite the Court of Appeal’s best intentions, to diminish the integrity of scientific evidence adduced in English criminal trials and distort its probative value

Designing and managing multiple pipelines

There is now a growing recognition that supply chains should be designed from ‘the customer backwards’ rather than from ‘the company outwards’. If such a view is accepted then the implication is that since the organisation will likely be serving multiple markets or segments there will be the need to design and manage multiple ‘pipelines’ to serve those different customers. To assist decision makers in their choice of appropriate supply chain design a framework is proposed based upon multiple criteria. A case study is presented which highlights the benefits of selecting, engineering and operating multiple pipelines tailored to the needs of th

Attack/Affect: System of a Down and Genocide Activism

This article problematizes the affective capacities of popular music to perform tactical and sometimes violent disruptions in conventional thought, especially when these capacities are oriented toward political activism. I offer a critical analysis of “Attack” and “Holy Mountains” (Hypnotize 2005), two songs by Los Angeles heavy metal band System of a Down. I also examine the melding of the disruptive aesthetics of heavy metal with socially conscious lyrics, and contestations over historical memory, specifically the recognition of the Armenian genocide. I ask what potential this music has to signal new and different ways of (re)thinking history and inquire into the questions that arise from such a strategy

Renal function, uraemia and early arteriovenous fistula failure

Background Guidance varies regarding the optimal timing of arteriovenous fistula (AVF) creation. The aim of this study was to evaluate the association between uraemia, haemodialysis and early AVF failure. Methods Immunoblotting and cell proliferation assays were performed on vascular smooth muscle cells (VSM) cells isolated from long saphenous vein samples to evaluate the cells’ ability to proliferate when stimulated with uraemic (post-dialysis) and hyperuraemic (pre-dialysis) serum. Clinical data was collected prospectively for 569 consecutive radiocephalic (RCF) and brachiocephalic (BCF) fistulae. The primary outcome was AVF failure at 6 weeks. Dialysis status (haemodialysis (HD); pre-dialysis (Pre-D)), eGFR and serum urea were evaluated to determine if they affected early AVF failure. Results Human VSM cells demonstrated increased capacity to proliferate when stimulated with hyperuraemic serum. There was no significant difference in early failure rate of either RCF or BCF depending on dialysis status (pre-D RCF 31.4% (n = 188); pre-D BCF 22.4% (n = 165); HD RCF 29.3% (n = 99); HD BCF 25.9% (n = 116); p = 0.34). There was no difference in mean eGFR between those patients with early AVF failure and those without (11.2+/-0.2 ml/min/1.73 m2 vs. 11.6+/-0.4 ml/min/1.73 m2; p = 0.47). Uraemia was associated with early AVF failure (serum urea: 35.0+/-0.7 mg/dl vs. 26.6+/-0.3 mg/dl (p &lt; 0.001)). Conclusions We present the first in vivo evidence of an association between adverse early AVF outcomes and uraemia. This is supported mechanistically by in vitro work demonstrating a pro-mitogenic effect of hyperuraemic serum. We hypothesise that uraemia-driven upregulation of VSM cell proliferation at the site of surgical insult in contributes to higher early AVF failure rates.</p

Is neurosurgery referral warranted for small brain aneurysms?

The risk of rupture of a small cerebral aneurysm (<10 mm) is very low in asymptomatic patients who have never had a subarachnoid hemorrhage. Because the risk of morbidity and mortality from surgical intervention significantly exceeds that of nonsurgical monitoring for this group, primary care physicians do not need to refer patients with this condition to a neurosurgeon for clipping (strength of recommendation [SOR]: B, based on cohort and case-control studies). For patients managed conservatively, annual office follow-up and imaging evaluation should be considered, and is necessary if a specific symptom should arise (SOR: C, based on expert opinion)

Assessing the probative value of DNA evidence: guidance for judges, lawyers, forensic scientists and expert witnesses

Practical guidance for judges, lawyers, forensic scientists and expert witnesses on the logical analysis of DNA profiles, and their probative value in criminal proceedings. Explains technical aspects of DNA profiling and how this information should be presented and interpreted in criminal trials

Measurement of Resonant Frequency and Quality Factor of Microwave Resonators: Comparison of Methods

Precise microwave measurements of sample conductivity, dielectric, and magnetic properties are routinely performed with cavity perturbation measurements. These methods require the accurate determination of quality factor and resonant frequency of microwave resonators. Seven different methods to determine the resonant frequency and quality factor from complex transmission coefficient data are discussed and compared to find which is most accurate and precise when tested using identical data. We find that the nonlinear least-squares fit to the phase vs. frequency is the most accurate and precise when the signal-to-noise ratio is greater than 65. For noisier data, the nonlinear least squares fit to a Lorentzian curve is more accurate and precise. The results are general and can be applied to the analysis of many kinds of resonant phenomena.Comment: 29 pages, 11 figure

The ambivalences of piracy : BitTorrent media piracy and anti-capitalism

This thesis argues that a more nuanced study of online media piracy is necessary in order to augment the dominant focus on piracy's relationship to copyright. Copyright as a frame for understanding piracy's relationship to capitalism has left potentially more crucial areas of study neglected. An approach to understanding the relationship of media piracy to anticapitalist projects must engage with forms of media piracy in their specificity and not as a homogeneous field. The thesis argues that it is possible and necessary to push beyond the constraints of copyright activism and intellectual property and in so doing opens up new areas of inquiry into online media piracy's potential to challenge logics of property and commodification. Original research is presented in the form of a highly detailed description and analysis of private BitTorrent filesharing sites. These sites are secretive and yet to receive scholarly attention in such a detailed and systematic way. This research finds both public and private variants of BitTorrent media piracy to be highly ambivalent with regards to their transformative potentials in relation to capital and thus tempers more extreme views of piracy as wholly revolutionary and emancipatory, and those that see pirate as a 'simple' form of theft. Public and private BitTorrent filesharing are theorised through the lens of Autonomist Marxism, a perspective that has a novel view of technology both as a tool of domination and a force for potential emancipation. Piracy is analysed for its capacity to refuse the valorisation of the enjoyment of music or film via the surveillance and tracking of audiences, which has become typical for contemporary legal online distribution venues. The thesis further analyses BitTorrent piracy's relationship to the 'common', the shared capacities for creating knowledge, ideas, affects. The thesis concludes that further scholarly research must move beyond concerns for creators' remuneration and its focus on reforming existing copyright policy and instead engage with the emergent institutional structures of organised media piracy. Though publicly accessible BitTorrent piracy has contributed to a broadening of awareness about issues of access to information, such an awareness often leaves in place logics of private property and capitalist accumulation. Finally, the thesis argues that the richness and complexity of private sites' organisational valences carry with them greater potential for radically destabilising capitalist social relations with regard to the distribution of cultural production