All things being equal? Equality and diversity in careers education,information, advice and guidance

In its education chapter, the Commission’s first Triennial Review of evidence on inequality, How Fair is Britain? Equality, Human Rights and Good Relations in 2010, found that educational attainment has been transformed in recent years. Around half of young people are now getting good qualifications at 16 (5+ A*-C GCSEs or equivalent including English and Maths) and, in 2008/09, 2.4 million students enrolled in higher education in the UK – a considerable change from a time when educational opportunities were only available to a minority of young people. However, the evidence shows that educational attainment continues to be strongly associated with socio-economic background. Stereotypical information and guidance can limit young people’s options and aspirations at an early age. Careers advice often reinforces traditional choices and young people have limited information on the pay advantages of nontraditional routes. Nearly one in four young people say that they have not had enough information to make choices for their future. This rises to just under a quarter of disabled young people

Are all competencies equal in the eyes of residents? A multicenter study of emergency medicine residents’ interest in feedback

Introduction: Feedback, particularly real-time feedback, is critical to resident education.  The emergency medicine (EM) milestones were developed in 2012 to enhance resident assessment and many programs utilize them to provide focused resident feedback. The purpose of this study was to evaluate EM residents’ level of interest in receiving real-time feedback on each of the 23 milestone sub-competencies.Methods: This was a multicenter cross sectional study of EM residents. Participants were surveyed on their level of interest in receiving real-time on-shift feedback on each of the 23 milestone sub-competencies. Anonymous paper or computerized surveys were distributed to residents at three 4-year training programs and three 3-year training programs with a total of 223 resident respondents. Residents rated their level of interest in each milestone on a 6-point semantic differential response scale. Average level of interest was calculated for each of the 23 sub-competencies, both as an average of all 223 respondents as well as by individual postgraduate year (PGY) level of training. One-way ANOVA analysis was performed to determine statistical significance.Results: The overall survey response rate across all institutions was 82%. Emergency stabilization had the highest mean rating (5.47/6) while technology had the lowest rating (3.24/6). However, none of the 23 milestone sub-competencies were statistically significant based on ANOVA analysis.Conclusion: It is unclear whether residents ascribe much more value to certain sub-competency domains than others.  Further studies are necessary to determine whether residents’ sub-competency valuations need to be considered when developing an assessment or feedback program focusing on the 23 EM milestones

Development of Feeding Cues During Infancy and Toddlerhood

To enhance responsive feeding, this study aimed to characterize the development of feeding cues during infancy and toddlerhood

Rapidly Progressive Malignant Rhabdoid Tumor of the Omentum in an Adult. A Case Report and Review of the Literature

Introduction: Malignant Rhabdoid Tumors (MRT) are exceedingly rare neoplasms that characteristically occur in infants and children and sparsely develop in adults. Primary MRTs of the omentum are particularly rare.Presentation of Case: A previously healthy 24-year-old male who presented with progressive abdominal distention and nausea. Further investigations revealed ascites with multifocal omental-based tumors. Biopsy with immunohistochemistry demonstrated dually positive cells for cytokeratin and vimentin and loss of Integrase Interactor 1 (INI1), and Next generation sequencing showed a copy number loss of SMARCB1 which established the diagnosis of malignant rhabdoid tumor. The patient’s clinical course was characterized by rapid local and metastatic progression with subsequent clinical deterioration, and he expired within three weeks of his initial presentation.Conclusion: Herein we describe the clinical course, difficulty with diagnosis, and paucity of treatment options for a rare and very aggressive malignant tumor. The ideal treatment regimen for MRTs has yet to be elucidated and additional studies are required to discern therapies that offer benefit

Test-Retest Reliability of Standard Deviation of Lane Position as Assessed on a PC-Based Driving Simulator

Driving is an everyday activity that is commonly affected by neurologic disorders and medical treatments. A frequently used metric for assessing driving ability is the standard deviation of lane position (SDLP), or the amount that subjects “swerve” within their driving lane. This measurement has been used with individuals under the influence of alcohol, illicit drugs, and prescribed medications in both on-road and simulator studies. Although good test-retest reliability is critical if one is to measure change in individuals over time, there is surprisingly limited data regarding the test-retest reliability of SDLP. Objective. To examine the test-retest reliability of SDLP in subjects tested at (1) a 3-month retest interval (a time frame common to clinical trials), and (2) a year or longer retest interval (a time period over which one might track changes in neurologic patients. Methods. Group 1 completed retesting an average of 84 (s.d. = 8.1) days after their initial simulator assessment. Both HIV negative (HIV-; n = 16) and positive (HIV+; n = 13) subjects were included to explore short-term reliability in control and mildly ill patient groups. All HIV+ subjects were medically asymptomatic, and unlikely to experience HIV-related changes over this interval. Two HIV+ subjects were neuropsychologically (NP) impaired. Group 2 (n = 31), a different cohort, was retested an average of 19.8 (8.3) months after baseline. All subjects completed NP evaluations at baseline and follow-up, with NP status rated on a scale of 1 (above average) to 9 (severe impairment) by a clinician blinded to simulator performance. Twelve subjects (39%) were NP impaired. In order to examine reliability in a stable neurologic cohort, all subjects were selected because they remained at the same level of NP functioning at follow-up. SDLP was assessed in both groups using an interactive PC-based driving simulator that consisted of a monitor, steering wheel, and brake/accelerator pedals. Participants were required to maintain lane position while holding a constant speed (55 mph) and responding to divided attention tasks in the corner of the monitor. Group 2 completed an existing, standardized scenario (TOPS), while Group 1 completed a newly developed driving scenario. Both simulations lasted approximately 7 minutes. Results. Combined reliability for Group 1 was .74. Test-retest reliability was .68 for the HIVand .83 for the HIV+ subjects. For Group 2, SDLP was significantly correlated with NP functioning at baseline (r = .5, p = .005) and follow-up (r = .48, p = .006), with impaired subjects evidencing a higher SDLP than NP normal subjects at both baseline (mean of 1.9 vs 1.2; p = .006) and follow-up (1.7 vs 1.1, p = .01). Combined test-retest reliability for Group 2 was .86. The NP normal group had a test-retest reliability of .74; test-retest reliability for the NP impaired group was .87. Conclusions. SDLP is a reliable measure for periods ranging from months to years when assessed in cognitively stable subjects. As such, this may serve as a useful tool in tracking the effects of neurologic disorders and pharmacologic treatments on driving abilities

Particle-in-cell experiments examine electron diffusion by whistler-mode waves: 1. Benchmarking with a cold plasma

Using a particle-in-cell code, we study the diffusive response of electrons due to wave particle interactions with whistler-mode waves. The relatively simple configuration of field-aligned waves in a cold plasma is used in order to benchmark our novel method, and to compare with previous works that used a different modelling technique. In this boundary-value problem, incoherent whistler-mode waves are excited at the domain boundary, and then propagate through the ambient plasma. Electron diffusion characteristics are directly extracted from particle data across all available energy and pitch-angle space. The ‘nature’ of the diffusive response is itself a function of energy and pitch-angle, such that the rate of diffusion is not always constant in time. However, after an initial transient phase, the rate of diffusion tends to a constant, in a manner that is consistent with the assumptions of quasilinear diffusion theory. This work establishes a framework for future investigations on the nature of diffusion due to whistler-mode wave-particle interactions, using particle-in-cell numerical codes with driven waves as boundary value problems

Calculation of Fire Severity Factors and Fire Non-Suppression Probabilities For A DOE Facility Fire PRA

Over a 12 month period, a fire PRA was developed for a DOE facility using the NUREG/CR-6850 EPRI/NRC fire PRA methodology. The fire PRA modeling included calculation of fire severity factors (SFs) and fire non-suppression probabilities (PNS) for each safe shutdown (SSD) component considered in the fire PRA model. The SFs were developed by performing detailed fire modeling through a combination of CFAST fire zone model calculations and Latin Hypercube Sampling (LHS). Component damage times and automatic fire suppression system actuation times calculated in the CFAST LHS analyses were then input to a time-dependent model of fire non-suppression probability. The fire non-suppression probability model is based on the modeling approach outlined in NUREG/CR-6850 and is supplemented with plant specific data. This paper presents the methodology used in the DOE facility fire PRA for modeling fire-induced SSD component failures and includes discussions of modeling techniques for: • Development of time-dependent fire heat release rate profiles (required as input to CFAST), • Calculation of fire severity factors based on CFAST detailed fire modeling, and • Calculation of fire non-suppression probabilities

The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders a randomized clinical trial

IMPORTANCE: Transdiagnostic interventions have been developed to address barriers to the dissemination of evidence-based psychological treatments, but only a few preliminary studies have compared these approaches with existing evidence-based psychological treatments. OBJECTIVE: To determine whether the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is at least as efficacious as single-disorder protocols (SDPs) in the treatment of anxiety disorders. DESIGN, SETTING, AND PARTICIPANTS: From June 23, 2011, to March 5, 2015, a total of 223 patients at an outpatient treatment center with a principal diagnosis of panic disorder with or without agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, or social anxiety disorder were randomly assigned by principal diagnosis to the UP, an SDP, or a waitlist control condition. Patients received up to 16 sessions of the UP or an SDP for 16 to 21 weeks. Outcomes were assessed at baseline, after treatment, and at 6-month follow-up. Analysis in this equivalence trial was based on intention to treat. INTERVENTIONS: The UP or SDPs. MAIN OUTCOMES AND MEASURES: Blinded evaluations of principal diagnosis clinical severity rating were used to evaluate an a priori hypothesis of equivalence between the UP and SDPs. RESULTS: Among the 223 patients (124 women and 99 men; mean [SD] age, 31.1 [11.0] years), 88 were randomized to receive the UP, 91 to receive an SDP, and 44 to the waitlist control condition. Patients were more likely to complete treatment with the UP than with SDPs (odds ratio, 3.11; 95% CI, 1.44-6.74). Both the UP (Cohen d, −0.93; 95% CI, −1.29 to −0.57) and SDPs (Cohen d, −1.08; 95% CI, −1.43 to −0.73) were superior to the waitlist control condition at acute outcome. Reductions in clinical severity rating from baseline to the end of treatment (β, 0.25; 95% CI, −0.26 to 0.75) and from baseline to the 6-month follow-up (β, 0.16; 95% CI, −0.39 to 0.70) indicated statistical equivalence between the UP and SDPs. CONCLUSIONS AND RELEVANCE: The UP produces symptom reduction equivalent to criterion standard evidence-based psychological treatments for anxiety disorders with less attrition. Thus, it may be possible to use 1 protocol instead of multiple SDPs to more efficiently treat the most commonly occurring anxiety and depressive disorders.This study was funded by grant R01 MH090053 from the National Institute of Mental Health. (R01 MH090053 - National Institute of Mental Health)First author draf

Attachment style moderates partner presence effects on pain : A laser-evoked potentials study

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly citedSocial support is crucial for psychological and physical well-being. Yet, in experimental and clinical pain research, the presence of others has been found to both attenuate and intensify pain. To investigate the factors underlying these mixed effects, we administered noxious laser stimuli to 39 healthy women while their romantic partner was present or absent, and measured pain ratings and laser-evoked potentials to assess the effects of partner presence on subjective pain experience and underlying neural processes. Further, we examined whether individual differences in adult attachment style, alone or in interaction with the partner's level of attentional focus (manipulated to be either on or away from the participant) might modulate these effects. We found that the effects of partner presence versus absence on pain-related measures depended on adult attachment style but not partner attentional focus. The higher participants' attachment avoidance, the higher pain ratings and N2 and P2 local peak amplitudes were in the presence compared to the absence of the romantic partner. As laser-evoked potentials are thought to reflect activity relating to the salience of events, our data suggest that partner presence may influence the perceived salience of events threatening the body, particularly in individuals who tend to mistrust others.Peer reviewedFinal Published versio