Supervision and feedback for junior medical staff in Australian emergency departments: findings from the emergency medicine capacity assessment study

<p>Abstract</p> <p>Background</p> <p>Clinical supervision and feedback are important for the development of competency in junior doctors. This study aimed to determine the adequacy of supervision of junior medical staff in Australian emergency departments (EDs) and perceived feedback provided.</p> <p>Methods</p> <p>Semi-structured telephone surveys sought quantitative and qualitative data from ED Directors, Directors of Emergency Medicine Training, registrars and interns in 37 representative Australian hospitals; quantitative data were analysed with SPSS 15.0 and qualitative data subjected to content analysis identifying themes.</p> <p>Results</p> <p>Thirty six of 37 hospitals took part. Of 233 potential interviewees, 95 (40.1%) granted interviews including 100% (36/36) of ED Directors, and 96.2% (25/26) of eligible DEMTs, 24% (19/81) of advanced trainee/registrars, and 17% (15/90) of interns. Most participants (61%) felt the ED was adequately supervised in general and (64.2%) that medical staff were adequately supervised. Consultants and registrars were felt to provide most intern supervision, but this varied depending on shift times, with registrars more likely to provide supervision on night shift and at weekends. Senior ED medical staff (64%) and junior staff (79%) agreed that interns received adequate clinical supervision. Qualitative analysis revealed that good processes were in place to ensure adequate supervision, but that service demands, particularly related to access block and overcrowding, had detrimental effects on both supervision and feedback.</p> <p>Conclusions</p> <p>Consultants appear to provide the majority of supervision of junior medical staff in Australian EDs. Supervision and feedback are generally felt to be adequate, but are threatened by service demands, particularly related to access block and ED overcrowding.</p

Chemical Magnetoreception: Bird Cryptochrome 1a Is Excited by Blue Light and Forms Long-Lived Radical-Pairs

Cryptochromes (Cry) have been suggested to form the basis of light-dependent magnetic compass orientation in birds. However, to function as magnetic compass sensors, the cryptochromes of migratory birds must possess a number of key biophysical characteristics. Most importantly, absorption of blue light must produce radical pairs with lifetimes longer than about a microsecond. Cryptochrome 1a (gwCry1a) and the photolyase-homology-region of Cry1 (gwCry1-PHR) from the migratory garden warbler were recombinantly expressed and purified from a baculovirus/Sf9 cell expression system. Transient absorption measurements show that these flavoproteins are indeed excited by light in the blue spectral range leading to the formation of radicals with millisecond lifetimes. These biophysical characteristics suggest that gwCry1a is ideally suited as a primary light-mediated, radical-pair-based magnetic compass receptor

Compass magnetoreception in birds arising from photo-induced radical pairs in rotationally disordered cryptochromes

According to the radical pair model, the magnetic compass sense of migratory birds relies on photochemical transformations in the eye to detect the direction of the geomagnetic field. Magnetically sensitive radical pairs are thought to be generated in cryptochrome proteins contained in magnetoreceptor cells in the retina. A prerequisite of the current model is for some degree of rotational ordering of both the cryptochromes within the cells and of the cells within the retina so that the directional responses of individual molecules do not average to zero. Here, it is argued that anisotropic distributions of radical pairs can be generated by the photoselection effects that arise from the directionality of the light entering the eye. Light-induced rotational order among the transient radical pairs rather than intrinsic ordering of their molecular precursors is seen as the fundamental condition for a magnetoreceptor cell to exhibit an anisotropic response. A theoretical analysis shows that a viable compass magnetoreceptor could result from randomly oriented cryptochromes contained in randomly oriented cells distributed around the retina

Determination of radical re-encounter probability distributions from magnetic field effects on reaction yields.

Measurements are reported of the effects of 0-23 mT applied magnetic fields on the spin-selective recombination of Py*- and DMA*+ radicals formed in the photochemical reaction of pyrene and N,N-dimethylaniline. Singlet &lt;--&gt; triplet interconversion in [Py*- DMA*+] radical pairs is probed by investigating combinations of fully protonated and fully deuterated reaction partners. Qualitatively, the experimental B1/2 values for the four isotopomeric radical pairs agree with predictions based on the Weller equation using known hyperfine coupling constants. The amplitude of the "low field effect" (LFE) correlates well with the ratio of effective hyperfine couplings, aDMA/aPy. An efficient method is introduced for calculating the spin evolution of [Py*- DMA*+] radical pairs containing a total of 18 spin-1/2 and spin-1 magnetic nuclei. Quantitative analysis of the magnetic field effects to obtain the radical re-encounter probability distribution f (t )-a highly ill-posed and underdetermined problem-is achieved by means of Tikhonov and maximum entropy regularization methods. The resulting f (t ) functions are very similar for the four isotopomeric radical pairs and have significant amplitude between 2 and 10 ns after the creation of the geminate radical pair. This interval reflects the time scale of re-encounters that are crucial for generating the magnetic field effect. Computer simulations of generalized radical pairs containing six spin-1/2 nuclei show that Weller's equation holds approximately only when the radical pair recombination rate is comparable to the two effective hyperfine couplings and that a substantial LFE requires, but is not guaranteed by, the condition that the two effective hyperfine couplings differ by more than a factor of 5. In contrast, for very slow recombination, essentially any radical pair should show a significant LFE

Low-field optically detected EPR spectroscopy of transient photoinduced radical pairs.

The effects of simultaneously applied weak static and weak radio frequency magnetic fields on the recombination of transient (&lt;100 ns) radical pairs have been investigated using a low-field optically detected electron paramagnetic resonance technique. Measurements on the photoinduced electron-transfer reaction of perdeuterated pyrene with 1,3-dicyanobenzene using a approximately 0.3 mT radio frequency field at three separate frequencies (5, 20, and 65 MHz) in the presence of 0-4 mT static fields yield spectra that are strikingly sensitive to the frequency of the time-dependent field, to the strength of the static field, and to the relative orientation of the two fields. The spectra are simulated using a modified form of the gamma-COMPUTE algorithm originally devised for calculating magic angle spinning NMR spectra of polycrystalline samples. The essential features of the spectra are consistent with the radical pair mechanism and were satisfactorily simulated using parameters whose values are either known independently or for which estimates are readily available. The calculations included hyperfine couplings to four deuterons in the pyrene cation radical and three protons in the 1,3-dicyanobenzene anion radical. Spin-selective recombination was modeled using an exponential distribution of radical encounter times. The results are discussed in the context of the proposal that radical pair chemistry forms the basis of the magnetoreceptor that allows birds to sense the Earth's magnetic field as a source of compass information during migration

Radio frequency magnetic field effects on a radical recombination reaction: a diagnostic test for the radical pair mechanism.

The photoinduced electron-transfer reaction of chrysene with isomers of dicyanobenzene is used to demonstrate the sensitivity of a radical recombination reaction to the orientation and frequency (5-50 MHz) of a approximately 300 muT radio frequency magnetic field in the presence of a 0-4 mT static magnetic field. The recombination yield is detected via the fluorescence of the exciplex formed exclusively from the electronic singlet state of the radical ion pair Chr*+/DCB*-. Magnetic field effects are simulated using a modified version of the gamma-COMPUTE algorithm, devised for the simulation of magic angle spinning NMR spectra of powdered samples. The response of a chemical or biological system to simultaneously applied radio frequency and static or extremely low-frequency magnetic fields could form the basis for a diagnostic test for the operation of the radical pair mechanism that would not require prior knowledge of the nature and properties of the radical reaction

Effects of disorder and motion in a radical pair magnetoreceptor.

A critical requirement in the proposed chemical model of the avian magnetic compass is that the molecules that play host to the magnetically sensitive radical pair intermediates must be immobilized and rotationally ordered within receptor cells. Rotational disorder would cause the anisotropic responses of differently oriented radical pairs within the same cell to interfere destructively, while rapid molecular rotation would tend to average the crucial anisotropic magnetic interactions and induce electron spin relaxation, reducing the sensitivity to the direction of the geomagnetic field. So far, experimental studies have been able to shed little light on the required degree of ordering and immobilization. To address this question, computer simulations have been performed on a collection of radical pairs undergoing restricted rigid-body rotation, coherent anisotropic spin evolution, electron spin relaxation and spin-selective recombination reactions. It is shown that the ordering and motional constraints necessary for efficient magnetoreception can be simultaneously satisfied if the radical pairs are uniaxially ordered with a moderate order parameter and if their motional correlation time is longer than about a quarter of their lifetime