Investment case for two-year post university speciality training in family medicine in Tajikistan: how much is needed for continuing and scaling up the improved education of family doctors?

Background: A new two-year Post University Specialty Training (PUST) programme in family medicine was introduced to improve the quality of postgraduate speciality medical education in Tajikistan. Postgraduate education of family doctors (FDs) needs to be urgently scaled up, as 38% of FD positions in Tajikistan remained unfilled in 2018. Moreover, the international financial support for the PUST programme is ending. This investment case assesses the minimum funding needed for the continuation and scale-up of PUST and establishes the rationale for the investment in the light of a recent evaluation. Methods: The costs of the programme were calculated for 2018 and a scale-up forecast made for the period 2019-2023. The impact of the scale-up on the shortage of FDs was assessed. An evaluation using a Multiple Choice Questionnaire and Objective Structured Clinical Examination (OSCE) assessed and compared theoretical knowledge, clinical skills and competencies of PUST trained and conventionally trained FDs. Results: The annual costs of the programme were US$228,000 in 2018. The total investment needed for scaling up PUST from 31 new FDs in 2018 to 100 FD graduates each year by 2023 was US$ 802,000.However, when the retirement of FDs and population growth are considered, the scale-up will result only in maintaining the current level of FDs working and not solve the country's FD shortage. The PUST FDs demonstrated significantly better clinical skills than the conventionally trained interns, scoring 60 and 45% of OSCE points, respectively. Theoretical knowledge showed a similar trend; PUST FDs answered 44% and interns 38% of the questions correctly. Conclusions: The two-year PUST programme has clearly demonstrated it produces better skilled family doctors than the conventional one-year internship, albeit some enduring quality concerns do still prevail. The discontinuation of international support for PUST would be a major setback and risks potentially losing the benefits of the programme for family medicine and also other specialities. To guarantee the supply of adequately trained FDs and address the FD shortage, the PUST should be continued and scaled up. Therefore, it is essential that international support is extended and a gradual transition to sustainable national financing gets underway

Competing electric and magnetic excitations in backward electron scattering from heavy deformed nuclei

Important $E2$ contributions to the $(e,e^{\prime})$ cross sections of low-lying orbital $M1$ excitations are found in heavy deformed nuclei, arising from the small energy separation between the two excitations with $I^{\pi}K = 2^+1$ and 1$^+1$, respectively. They are studied microscopically in QRPA using DWBA. The accompanying $E2$ response is negligible at small momentum transfer $q$ but contributes substantially to the cross sections measured at $\theta = 165 ^{\circ}$ for $0.6 < q_{\rm eff} < 0.9$ fm$^{-1}$ ($40 \le E_i \le 70$ MeV) and leads to a very good agreement with experiment. The electric response is of longitudinal $C2$ type for $\theta \le 175 ^{\circ}$ but becomes almost purely transverse $E2$ for larger backward angles. The transverse $E2$ response remains comparable with the $M1$ response for $q_{\rm eff} > 1.2$ fm$^{-1}$ ($E_i > 100$ MeV) and even dominant for $E_i > 200$ MeV. This happens even at large backward angles $\theta > 175 ^{\circ}$, where the $M1$ dominance is limited to the lower $q$ region.Comment: RevTeX, 19 pages, 8 figures included Accepted for publication in Phys Rev

Medical education reform in Tajikistan: comparison of the conventional one-year family medicine residency program and the new two-year residency program for postgraduate medical education

INTRODUCTION: The last two decades have seen a shift in former Soviet countries from highly specialized to more family medicine-focused systems. Medical education has slowly adjusted to these reforms, although the region is still at risk to have a chronic shortage of family doctors. This paper presents the evaluation of a new post-graduate family medicine program in Tajikistan, focused on competency-based training. The findings are relevant for policy makers, international organizations and practitioners participating in similar medical education reform programs. METHODS: We employed a quasi-experimental control group design and compared intervention residents, control group residents with traditional training, and 1st year residents with no training in two outcomes, clinical knowledge and competencies. We employed two objective measures, a written multiple-choice question test (MCQT) and an Objective Structured Clinical Examination (OSCE), respectively. We report reliability and validity of the measures along with ANOVA, planned contrasts and effect size estimates to examine differences across groups. RESULTS: We found statistically significant differences in both clinical knowledge and competencies between intervention and control groups. We also detected a large intervention effect size. Participants in the intervention outperformed control group participants in the two measures. Our analysis suggests that intervention and control group participants are comparable in terms of initial knowledge and competencies, strengthening the argument that the intervention caused the improvement in the program outcomes. DISCUSSION: Receiving tailored training and structured opportunities to practice knowledge and competencies in clinical settings have a positive effect on the education of family medicine doctors in Tajikistan. Our results support curriculum reform and investment in medical education in the form of longer and supervised on-the-job preparation designed to be more in line with international standards. We discuss suggestions for future studies and potential requirements to inform replicability in other countries. CONCLUSION: Family medicine is well recognized as central to health systems throughout the world, but high quality residency training lags behind in some countries. Our study showed that investing in family medicine residency programs and structured training is effective in increasing critical clinical competencies. We encourage promoting comprehensive post graduate family medicine doctor training so that the goals of a family medicine centered health system are attainable

Scissors modes in triaxial metal clusters

We study the scissors mode (orbital M1 excitations) in small Na clusters, triaxial metal clusters ${\rm Na}_{12}$ and ${\rm Na}_{16}$ and the close-to-spherical ${{\rm Na}_9}^+$, all described in DFT with detailed ionic background. The scissors modes built on spin-saturated ground and spin-polarized isomeric states are analyzed in virtue of both macroscopic collective and microscopic shell-model treatments. It is shown that the mutual destruction of Coulomb and the exchange-correlation parts of the residual interaction makes the collective shift small and the net effect can depend on details of the actual excited state. The crosstalk with dipole and spin-dipole modes is studied in detail. In particular, a strong crosstalk with spin-dipole negative-parity mode is found in the case of spin-polarized states. Triaxiality and ionic structure considerably complicate the scissors response, mainly at expense of stronger fragmentation of the strength. Nevertheless, even in these complicated cases the scissors mode is mainly determined by the global deformation. The detailed ionic structure destroys the spherical symmetry and can cause finite M1 response (transverse optical mode) even in clusters with zero global deformation. But its strength turns out to be much smaller than for the genuine scissors modes in deformed systems.Comment: 17 pages, 5 figure

Transition Rates between Mixed Symmetry States: First Measurement in 94Mo

The nucleus 94Mo was investigated using a powerful combination of gamma-singles photon scattering experiments and gamma-gamma-coincidence studies following the beta-decay of 94mTc. The data survey short-lived J^pi=1+,2+ states and include branching ratios, E2/M1 mixing ratios, lifetimes, and transition strengths. The mixed-symmetry (MS) 1+ scissors mode and the 2+ MS state are identified from M1 strengths. A gamma transition between MS states was observed and its rate was measured. Nine M1 and E2 strengths involving MS states agree with the O(6) limit of the interacting boson model-2 using the proton boson E2 charge as the only free parameter.Comment: 9 pages, 3 PostScript figures included, ReVTeX, accepted for publication in Physical Review Letters, tentatively scheduled for August 9, 199

Switchable Coupling of Vibrations to Two-Electron Carbon-Nanotube Quantum Dot States

We report transport measurements on a quantum dot in a partly suspended carbon nanotube. Electrostatic tuning allows us to modify and even switch 'on' and 'off' the coupling to the quantized stretching vibration across several charge states. The magnetic-field dependence indicates that only the two-electron spin-triplet excited state couples to the mechanical motion, indicating mechanical coupling to both the valley degree of freedom and the exchange interaction, in contrast to standard models

Nuclear Scissors Mode with Pairing

The coupled dynamics of the scissors mode and the isovector giant quadrupole resonance are studied using a generalized Wigner function moments method taking into account pair correlations. Equations of motion for angular momentum, quadrupole moment and other relevant collective variables are derived on the basis of the time dependent Hartree-Fock-Bogoliubov equations. Analytical expressions for energy centroids and transitions probabilities are found for the harmonic oscillator model with the quadrupole-quadrupole residual interaction and monopole pairing force. Deformation dependences of energies and $B(M1)$ values are correctly reproduced. The inclusion of pair correlations leads to a drastic improvement in the description of qualitative and quantitative characteristics of the scissors mode.Comment: 36 pages, 5 figures, the results of calculation by another method and the section concerning currents are adde

Polydispersity and ordered phases in solutions of rodlike macromolecules

We apply density functional theory to study the influence of polydispersity on the stability of columnar, smectic and solid ordering in the solutions of rodlike macromolecules. For sufficiently large length polydispersity (standard deviation $\sigma>0.25$) a direct first-order nematic-columnar transition is found, while for smaller $\sigma$ there is a continuous nematic-smectic and first-order smectic-columnar transition. For increasing polydispersity the columnar structure is stabilized with respect to solid perturbations. The length distribution of macromolecules changes neither at the nematic-smectic nor at the nematic-columnar transition, but it does change at the smectic-columnar phase transition. We also study the phase behaviour of binary mixtures, in which the nematic-smectic transition is again found to be continuous. Demixing according to rod length in the smectic phase is always preempted by transitions to solid or columnar ordering.Comment: 13 pages (TeX), 2 Postscript figures uuencode

Topological Defects in Nematic Droplets of Hard Spherocylinders

Using computer simulations we investigate the microscopic structure of the singular director field within a nematic droplet. As a theoretical model for nematic liquid crystals we take hard spherocylinders. To induce an overall topological charge, the particles are either confined to a two-dimensional circular cavity with homeotropic boundary or to the surface of a three-dimensional sphere. Both systems exhibit half-integer topological point defects. The isotropic defect core has a radius of the order of one particle length and is surrounded by free-standing density oscillations. The effective interaction between two defects is investigated. All results should be experimentally observable in thin sheets of colloidal liquid crystals.Comment: 13 pages, 16 figures, Phys. Rev.