Auscultating heart and breath sounds through patients’ gowns: who does this and does it matter?

Background Doctors are taught to auscultate with the stethoscope applied to the skin, but in practice may be seen applying the stethoscope to the gown. Objectives To determine how often doctors auscultate heart and breath sounds through patients’ gowns, and to assess the impact of this approach on the quality of the sounds heard. Methods A sample of doctors in the west of Scotland were sent an email in 2014 inviting them to answer an anonymous questionnaire about how they auscultated heart and breath sounds. Normal heart sounds from two subjects were recorded through skin, through skin and gown, and through skin, gown and dressing gown. These were played to doctors, unaware of the origin of each recording, who completed a questionnaire about the method and quality of the sounds they heard. Results 206 of 445 (46%) doctors completed the questionnaire. 124 (60%) stated that they listened to patients’ heart sounds, and 156 (76%) to patients’ breath sounds, through patients’ gowns. Trainees were more likely to do this compared with consultants (OR 3.39, 95% CI 1.74 to 6.65). Doctors of all grades considered this practice affected the quality of the sounds heard. 32 doctors listened to the recorded heart sounds. 23 of the 64 (36%) skin and 23 of the 64 (36%) gown recordings were identified. The majority of doctors (74%) could not differentiate between skin or gown recordings, but could tell them apart from the double layer recordings (p=0.02). Trainees were more likely to hear artefactual added sounds (p=0.04). Conclusions Many doctors listen to patients’ heart and breath sounds through hospital gowns, at least occasionally. In a short test, most doctors could not distinguish between sounds heard through a gown or skin. Further work is needed to determine the impact of this approach to auscultation on the identification of murmurs and added sounds

Talking the line: inclusive strategies for the teaching of drawing

The article reports on a series of drawing workshops held at the Royal College of Art (RCA), London, which tested an original pedagogical strategy designed to help dyslexic and/or dyspraxic art and design students who had reported difficulties with their abilities to make accurate representational drawings. A group of non-dyslexic/dyspraxic RCA students volunteered as control group, and both cohorts completed three days of workshops in the Drawing Studio of the RCA. Results of recorded interviews eliciting student observations as they drew, and a questionnaire in the form of a Likert scale, administered before and after the workshop, indicate positive shifts in both cohorts’ attitudes towards specific aspects of the stages involved in the production of accurate representational drawings of still-life set-ups, the human skeleton and the clothed life-model. Assessment of the drawings produced indicates positive shifts in the two cohorts in geometric accuracy and other qualitative criteria embedded in the teaching strategy such as control of scale, proportion and illusions of depth. Both cohorts displayed similar positive attitude shifts and both sets of drawings indicated similar positive shifts in visual qualities. An interim conclusion posits that the pedagogical strategy appears to enhance the abilities of both dyslexic/dyspraxic students and non-dyslexic/dyspraxic students to make accurate representational drawings. This result correlates closely with the findings of an earlier, prototype workshop held at the RCA in July 2012. It is suggested that similar pedagogically inclusive strategies might produce positive results in the context of secondary schools as part of a more inclusive curriculum

Learning to perceive: informing pedagogic practice through the empirical study of drawing

This paper is the result of collaboration between psychologists with an interest in the cognitive processes underpinning drawing activity (Chamberlain, McManus and Brunswick), a dyslexia support tutor (Rankin) and an art school lecturer in drawing (Riley). It reports on a small-scale, ‘pilot’ workshop, designed to test the pedagogical strategies specifically designed for dyslexic students, with a cohort of volunteers from across the Royal College of Art, London

Scratching the surface: practice, personality, approaches to learning and the acquisition of high level representational drawing ability

Accurate representational drawing is a complex skill which underpins performance in many branches of the visual arts. Research suggests that expertise typically is acquired as a result of deliberate practice and a flexible approach to learning strategies. The current study investigated how, in art students, differences in the acquisition of observational drawing skill could be characterised using domain-general expertise accounts. A cohort of undergraduate and postgraduate art students (n=682) completed questionnaires about self-perceived artistic abilities, personality and approaches to learning. A subset completed tasks of actual drawing ability (n=301), the Rey-Osterrieth Complex Figure (ROCF) test and a performance IQ test. Actual drawing ability related to time spent drawing and drawing techniques, with additional independent predictive effects of both the copying and delayed ROCF test. Effects of personality were mainly mediated via learning styles, with surface learners spending more time drawing, learning fewer techniques and acquiring a lower level of actual skill. Deep learners learned more drawing techniques, and strategic (achieving) learners acquired a higher level of drawing skill overall. The resulting model of drawing ability development has the potential to be generalised over a range of creative and non-creative domains

Complete Experimental Structure Determination of the p(3x2)pg Phase of Glycine on Cu{110}

We present a quantitative low energy electron diffraction (LEED) surface-crystallograpic study of the complete adsorption geometry of glycine adsorbed on Cu{110} in the ordered p(3×2) phase. The glycine molecules form bonds to the surface through the N atoms of the amino group and the two O atoms of the de-protonated carboxylate group, each with separate Cu atoms such that every Cu atom in the first layer is involved in a bond. Laterally, N atoms are nearest to the atop site (displacement 0.41 Å). The O atoms are asymmetrically displaced from the atop site by 0.54 Å and 1.18 Å with two very different O-Cu bond lengths of 1.93 Å and 2.18 Å. The atom positions of the upper-most Cu layers show small relaxations within 0.07 Å of the bulk-truncated surface geometry. The unit cell of the adsorbate layer consists of two glycine molecules, which are related by a glide-line symmetry operation. This study clearly shows that a significant coverage of adsorbate structures without this glide-line symmetry must be rejected, both on the grounds of the energy dependence of the spot intensities (LEED-IV curves) and of systematic absences in the LEED pattern

Letter from W. H. Elson, Edwin B. Cox, C. N. Kendall, F. T. Oldt, and A. W. Rankin

Letter concerning resolutions being voted on concerning the National Educational Association

On uniformization of Burnside's curve y2=x5−xy^2=x^5-x

Main objects of uniformization of the curve $y^2=x^5-x$ are studied: its Burnside's parametrization, corresponding Schwarz's equation, and accessory parameters. As a result we obtain the first examples of solvable Fuchsian equations on torus and exhibit number-theoretic integer $q$-series for uniformizing functions, relevant modular forms, and analytic series for holomorphic Abelian integrals. A conjecture of Whittaker for hyperelliptic curves and its hypergeometric reducibility are discussed. We also consider the conversion between Burnside's and Whittaker's uniformizations.Comment: Final version. LaTeX, 23 pages, 1 figure. The handbook for elliptic functions has been moved to arXiv:0808.348

Pulsar Magnetospheric Emission Mapping: Images and Implications of Polar-Cap Weather

The beautiful sequences of ``drifting'' subpulses observed in some radio pulsars have been regarded as among the most salient and potentially instructive characteristics of their emission, not least because they have appeared to represent a system of subbeams in motion within the emission zone of the star. Numerous studies of these ``drift'' sequences have been published, and a model of their generation and motion articulated long ago by Ruderman & Sutherland (1975); but efforts thus far have failed to establish an illuminating connection between the drift phemomenon and the actual sites of radio emission. Through a detailed analysis of a nearly coherent sequence of ``drifting'' pulses from pulsar B0943+10, we have in fact identified a system of subbeams circulating around the magnetic axis of the star. A mapping technique, involving a ``cartographic'' transform and its inverse, permits us to study the character of the polar-cap emission ``map'' and then to confirm that it, in turn, represents the observed pulse sequence. On this basis, we have been able to trace the physical origin of the ``drifting-subpulse'' emission to a stably rotating and remarkably organized configuration of emission columns, in turn traceable possibly to the magnetic polar-cap ``gap'' region envisioned by some theories.Comment: latex with five eps figure

AXL modulates extracellular matrix protein expression and is essential for invasion and metastasis in endometrial cancer

The receptor tyrosine kinase AXL promotes migration, invasion, and metastasis. Here, we evaluated the role of AXL in endometrial cancer. High immunohistochemical expression of AXL was found in 76% (63/83) of advanced-stage, and 77% (82/107) of high-grade specimens and correlated with worse survival in uterine serous cancer patients. In vitro, genetic silencing of AXL inhibited migration and invasion but had no effect on proliferation of ARK1 endometrial cancer cells. AXL-deficient cells showed significantly decreased expression of phospho-AKT as well as uPA, MMP-1, MMP-2, MMP-3, and MMP-9. In a xenograft model of human uterine serous carcinoma with AXL-deficient ARK1 cells, there was significantly less tumor burden than xenografts with control ARK1 cells. Together, these findings underscore the therapeutic potentials of AXL as a candidate target for treatment of metastatic endometrial cancer