Generational differences in factors influencing physicians to choose a work location.

INTRODUCTION: Canadian medical schools have increased enrolment and recruited more rural students in an effort to address general and rural physician shortages. The success of this approach depends on the recruitment of these newly trained physicians to under-serviced areas. Studies from North America suggest that the career expectations and practice patterns of younger, more recently graduated physicians differ from those of their older counterparts. This study explored the factors that influenced the work location choices of physicians of differing generations, who trained at universities in Saskatchewan, and Newfoundland and Labrador, two Canadian provinces with large rural populations and no community larger than 235 000 population. METHODS: Semi-structured, qualitative interviews were conducted with physicians who graduated from either the Memorial University of Newfoundland or the University of Saskatchewan. Generation definitions were based on the graduation year. Early-career physicians graduated between 1995 and 1999; mid-career physician graduated between 1985 and 1989; late-career physicians graduated between 1975 and 1979; and end-career physicians graduated between 1965 and 1969. Each physician was asked questions about the number and nature of work location changes over the course of their careers and the factors related to their decision to choose each location. Interview transcripts and notes were analyzed using a thematic analysis approach. Although the study focus was on generational differences, similarities and differences between universities, sexes and specialties (family physicians/GPs vs specialists) were also examined. Recruitment to the provinces was focused on as a whole, because the largest communities in the provinces are small compared with most urban communities. RESULTS: Forty-eight physicians were interviewed, five to nine physicians who graduated in each decade and from each university. The desire to be near family and friends was cited as the primary consideration when choosing a work location, regardless of generation. Likewise, residency training location, the ability to use their skills and knowledge fully, and the quality of recruitment efforts were important considerations in choosing a work location for all physicians. For some, remuneration was very influential in their work location decision; however, many physicians who chose to remain in their smaller 'home' provinces noted the lower cost of living in these provinces. Physicians who graduated in the 1980s and 1990s placed greater emphasis on work-life balance and spouse's employment opportunities than their older generation counterparts. In contrast, physicians who graduated in the 1960s and 1070s highlighted the medical need of the community, and the desire for adventure and to see new places as important. CONCLUSIONS: While many factors for choosing a work location appear to be stable over generations, a number of generational differences were found. Younger physicians placed greater emphasis on work-life balance and spouse's employment than older generation physicians. These differences may have important implications for small population regions which may not be able to support physician-spouse pairs or certain subspecialties. Although economic factors have largely been the focus of recruitment and retention initiatives in these provinces, the findings highlight the importance of addressing the needs and expectations of younger generation physicians in order to attract these physicians

Blood transfusion in the critically ill: does storage age matter?

Morphologic and biochemical changes occur during red cell storage prior to product expiry, and these changes may hinder erythrocyte viability and function following transfusion. Despite a relatively large body of literature detailing the metabolic and structural deterioration that occurs during red cell storage, evidence for a significant detrimental clinical effect related to the transfusion of older blood is relatively less conclusive, limited primarily to observations in retrospective studies. Nonetheless, the implication that the transfusion of old, but not outdated blood may have negative clinical consequences demands attention. In this report, the current understanding of the biochemical and structural changes that occur during storage, known collectively as the storage lesion, is described, and the clinical evidence concerning the detrimental consequences associated with the transfusion of relatively older red cells is critically reviewed. Although the growing body of literature demonstrating the deleterious effects of relatively old blood is compelling, it is notable that all of these reports have been retrospective, and most of these studies have evaluated patients who received a mixture of red cell units of varying storage age. Until prospective studies have been completed and produce confirmative results, it would be premature to recommend any modification of current transfusion practice regarding storage age

Dual Infection and Superinfection Inhibition of Epithelial Skin Cells by Two Alphaherpesviruses Co-Occur in the Natural Host

Hosts can be infected with multiple herpesviruses, known as superinfection; however, superinfection of cells is rare due to the phenomenon known as superinfection inhibition. It is believed that dual infection of cells occurs in nature, based on studies examining genetic exchange between homologous alphaherpesviruses in the host, but to date, this has not been directly shown in a natural model. In this report, gallid herpesvirus 2 (GaHV-2), better known as Marek’s disease virus (MDV), was used in its natural host, the chicken, to determine whether two homologous alphaherpesviruses can infect the same cells in vivo. MDV shares close similarities with the human alphaherpesvirus, varicella zoster virus (VZV), with respect to replication in the skin and exit from the host. Recombinant MDVs were generated that express either the enhanced GFP (eGFP) or monomeric RFP (mRFP) fused to the UL47 (VP13/14) herpesvirus tegument protein. These viruses exhibited no alteration in pathogenic potential and expressed abundant UL47-eGFP or -mRFP in feather follicle epithelial cells in vivo. Using laser scanning confocal microscopy, it was evident that these two similar, but distinguishable, viruses were able to replicate within the same cells of their natural host. Evidence of superinfection inhibition was also observed. These results have important implications for two reasons. First, these results show that during natural infection, both dual infection of cells and superinfection inhibition can co-occur at the cellular level. Secondly, vaccination against MDV with homologous alphaherpesvirus like attenuated GaHV-2, or non-oncogenic GaHV-3 or meleagrid herpesvirus (MeHV-1) has driven the virus to greater virulence and these results implicate the potential for genetic exchange between homologous avian alphaherpesviruses that could drive increased virulence. Because the live attenuated varicella vaccine is currently being administered to children, who in turn could be superinfected by wild-type VZV, this could potentiate recombination events of VZV as well

The Timing of the Cognitive Cycle

We propose that human cognition consists of cascading cycles of recurring brain events. Each cognitive cycle senses the current situation, interprets it with reference to ongoing goals, and then selects an internal or external action in response. While most aspects of the cognitive cycle are unconscious, each cycle also yields a momentary “ignition” of conscious broadcasting. Neuroscientists have independently proposed ideas similar to the cognitive cycle, the fundamental hypothesis of the LIDA model of cognition. High-level cognition, such as deliberation, planning, etc., is typically enabled by multiple cognitive cycles. In this paper we describe a timing model LIDA's cognitive cycle. Based on empirical and simulation data we propose that an initial phase of perception (stimulus recognition) occurs 80–100 ms from stimulus onset under optimal conditions. It is followed by a conscious episode (broadcast) 200–280 ms after stimulus onset, and an action selection phase 60–110 ms from the start of the conscious phase. One cognitive cycle would therefore take 260–390 ms. The LIDA timing model is consistent with brain evidence indicating a fundamental role for a theta-gamma wave, spreading forward from sensory cortices to rostral corticothalamic regions. This posteriofrontal theta-gamma wave may be experienced as a conscious perceptual event starting at 200–280 ms post stimulus. The action selection component of the cycle is proposed to involve frontal, striatal and cerebellar regions. Thus the cycle is inherently recurrent, as the anatomy of the thalamocortical system suggests. The LIDA model fits a large body of cognitive and neuroscientific evidence. Finally, we describe two LIDA-based software agents: the LIDA Reaction Time agent that simulates human performance in a simple reaction time task, and the LIDA Allport agent which models phenomenal simultaneity within timeframes comparable to human subjects. While there are many models of reaction time performance, these results fall naturally out of a biologically and computationally plausible cognitive architecture

Computational analysis of expression of human embryonic stem cell-associated signatures in tumors

<p>Abstract</p> <p>Background</p> <p>The cancer stem cell model has been proposed based on the linkage between human embryonic stem cells and human cancer cells. However, the evidences supporting the cancer stem cell model remain to be collected. In this study, we extensively examined the expression of human embryonic stem cell-associated signatures including core genes, transcription factors, pathways and microRNAs in various cancers using the computational biology approach.</p> <p>Results</p> <p>We used the class comparison analysis and survival analysis algorithms to identify differentially expressed genes and their associated transcription factors, pathways and microRNAs among normal vs. tumor or good prognosis vs. poor prognosis phenotypes classes based on numerous human cancer gene expression data. We found that most of the human embryonic stem cell- associated signatures were frequently identified in the analysis, suggesting a strong linkage between human embryonic stem cells and cancer cells.</p> <p>Conclusions</p> <p>The present study revealed the close linkage between the human embryonic stem cell associated gene expression profiles and cancer-associated gene expression profiles, and therefore offered an indirect support for the cancer stem cell theory. However, many interest issues remain to be addressed further.</p

Exploring the psychological factors involved in the Ladbroke Grove rail accident

Ten years after the event and the question as to exactly why a driver passed a signal at danger to cause the Ladbroke Grove rail disaster is still an open one. This paper uses the literature on human error and cognition, combined with critical path analysis, to provide further insight. Five aspects of train operation are drawn out of the known facts surrounding the incident: custom and practice in the use of the Driver's Reminder Appliance, operation and use of the Automatic Warning System, the sequence of signalling information, methods of supplying route information, and speed restrictions. Associated with each are several important human factors issues which, combined, give rise to five potential explanations. Critical path analysis is used to map these explanations onto the known facts of the situation. It is suggested that the proximal cause of the Ladbroke Grove rail crash was a combination of an association–activation error and a mode error (leading the driver to mistakenly assume he had activated the Reminder Appliance) together with a loss-of-activation error (the driver failing to remember that a previous signal was showing caution) and a data-driven-activation error (by associating an in-cab warning to the wrong external source). The findings support the original inquiry recommendations, but also go further into predictive methods of detecting problems at the human/transport system interfac