Preregistration house officers in general practice: review of evidence

OBJECTIVES: To examine the strengths and weaknesses of the national and local schemes for preregistration house officers to spend four months in general practice, to identify any added value from such placements, and to examine the impact on career choices. DESIGN: Review of all studies that reported on placements of preregistration house officers in general practice. SETTING: 19 accounts of preregistration house officers’ experience in general practice, ranging from single case reports to a national evaluation study, in a variety of locations in Scotland and England. PARTICIPANTS: Views of 180 preregistration house officers, 45 general practitioner trainers, and 105 consultant trainers. MAIN OUTCOME MEASURES: Main findings or themes weighted according to number of studies reporting them and weighted for sample size. RESULTS: The studies were unanimous about the educational benefits of the placements. The additional learning included communication skills, social and psychological factors in illness, patient centred consultations, broadening of knowledge base, and dealing with uncertainty about diagnosis and referral. CONCLUSIONS: Despite the reported benefits and recommendations of the scheme, it is not expanding. General practitioner trainers reported additional supervision that was unremunerated. The reforms of the senior house officer grade may resolve this problem by offering the placements to senior house officers, who require less supervision

Boosting clinical performance: The impact of enhanced final year placements.

BACKGROUND: This study follows on from a study that investigated how to develop effective final year medical student assistantship placements, using multidisciplinary clinical teams in planning and delivery. AIMS: This study assessed the effects on objective structured clinical examination (OSCE) performance of the in-course enhanced "super-assistantship" placement introduced to a randomly selected sample of 2013-14 final year medical students at Leeds medical school. METHODS: Quantitative data analysis was used to compare the global grades of OSCE stations between students who undertook this placement against those who did not. RESULTS: There was a small overall improvement in the "super-assistantship" student scores across the whole assessment (effect size = 0.085). "Pre-op Capacity", "Admissions Prescribing" and "Hip Pain" stations had small-medium effect sizes (0.226, 0.215, and 0.214) in favor of the intervention group. Other stations had small effect sizes (0.107-0.191), mostly in favor of the intervention group. CONCLUSIONS: The "super-assistantship" experience characterized by increasing student responsibility on placement can help to improve competence and confidence in clinical decision-making "in a simulated environment". The clinical environment and multidisciplinary team must be ready and supported to provide these opportunities effectively. Further in-course opportunities for increasing final year student responsibility should be developed

AEROSPACE NUCLEAR SAFETY PROGRAM QUARTERLY REPORT, JULY 1--SEPTEMBER 30, 1970.

This report describes research, development, support, and test activities in the Sandia Laboratory Aerospace Nuclear Safety Program from July 1 through September 30, 1970

User perceptions of multi-source feedback tools for junior doctors

Context:  The effectiveness of multi-source feedback (MSF) tools, which are increasingly important in medical careers, will be influenced by their users’ attitudes. This study compared perceptions of two tools for giving MSF to UK junior doctors, of which one provides mainly textual feedback and one provides mainly numerical feedback. We then compared the perceptions of three groups, including: trainees; raters giving feedback, and supervisors delivering feedback. Methods:  Postal questionnaires about the usability, usefulness and validity of a feedback system were distributed to trainees, raters and supervisors across the north of England. Results:  Questionnaire responses were analysed to compare opinions of the two tools and among the different user groups. Overall there were few differences. Attitudes towards MSF in principle were positive and the tools were felt to be usable, but there was little agreement that they could effectively identify doctors in difficulty or provide developmental feedback. The text-oriented tool was rated as more useful for giving feedback on communication and attitude, and as more useful for identifying a doctor in difficulty. Raters were more positive than other users about the usefulness of numerical feedback, but, overall, text was felt to be more useful. Some trainees expressed concern that feedback was based on insufficient knowledge of their work. This was not supported by raters’ responses, although many did use indirect information. Trainees selected raters mainly for the perceived value of their feedback, but also based on personal relationships and the simple pragmatics of getting a tool completed. Discussion:  Despite positive attitudes to MSF, the perceived effectiveness of the tools was low. There are small but significant preferences for textual feedback, although raters may prefer numerical scales. Concerns about validity imply that greater awareness of contextual and psychological influences on feedback generation is necessary to allow the formative benefits of MSF to be optimised and to negate the risk of misuse in high-stakes contexts

Controlling Fast Chaos in Delay Dynamical Systems

We introduce a novel approach for controlling fast chaos in time-delay dynamical systems and use it to control a chaotic photonic device with a characteristic time scale of ~12 ns. Our approach is a prescription for how to implement existing chaos control algorithms in a way that exploits the system's inherent time-delay and allows control even in the presence of substantial control-loop latency (the finite time it takes signals to propagate through the components in the controller). This research paves the way for applications exploiting fast control of chaos, such as chaos-based communication schemes and stabilizing the behavior of ultrafast lasers.Comment: 4 pages, 4 figures, to be published in Physical Review Letter

Spatial Relationship between Solar Flares and Coronal Mass Ejections

We report on the spatial relationship between solar flares and coronal mass ejections (CMEs) observed during 1996-2005 inclusive. We identified 496 flare-CME pairs considering limb flares (distance from central meridian > 45 deg) with soft X-ray flare size > C3 level. The CMEs were detected by the Large Angle and Spectrometric Coronagraph (LASCO) on board the Solar and Heliospheric Observatory (SOHO). We investigated the flare positions with respect to the CME span for the events with X-class, M-class, and C-class flares separately. It is found that the most frequent flare site is at the center of the CME span for all the three classes, but that frequency is different for the different classes. Many X-class flares often lie at the center of the associated CME, while C-class flares widely spread to the outside of the CME span. The former is different from previous studies, which concluded that no preferred flare site exists. We compared our result with the previous studies and conclude that the long-term LASCO observation enabled us to obtain the detailed spatial relation between flares and CMEs. Our finding calls for a closer flare-CME relationship and supports eruption models typified by the CSHKP magnetic reconnection model.Comment: 7 pages; 4 figures; Accepted by the Astrophysical Journa

Inflation und Schuldenabbau

Die Rettungsaktionen der EZB stehen in der Kritik: Es wird befürchtet, dass sie zu steigenden Inflationsraten führen könnten. Die Autoren des Zeitgesprächs sehen diese Gefahr nicht. Vielmehr könne ein gemäßigter Anstieg der Inflation sogar dazu beitragen, die Staatsschulden schneller abzubauen. Die Autoren aus dem DIW sehen hier allerdings die Wiedereinführung der Vermögensteuer und eine einmalige Vermögensabgabe als eine gerechtere und transparentere Alternative an.The European Central Bank (ECB) recently announced its willingness to do whatever is needed to save the euro. This has raised the question whether such a role of the ECB must lead to higher rates of inflation. Under current recessive macroeconomic conditions in the eurozone, the ECB's expansionary monetary policy will not lead to higher inflation. On the contrary, there is a serious danger of deflation. Higher inflation would likely occur only if a permanent stabilisation function were assigned to the ECB. Yet historical examples show that mistakes can be made. During the stagnation in Japan, US economists heavily criticised the Bank of Japan's timid monetary policy response. But in some sense, current Fed policy seems to be a direct copy of that strategy, caused by uncertainty about the proper communication channel. An inflation tax could help to bring down the mounting public debt in the wake of the financial crisis, but higher wealth taxes have more transparent distributional effects

Experiments with a Malkus-Lorenz water wheel: Chaos and Synchronization

We describe a simple experimental implementation of the Malkus-Lorenz water wheel. We demonstrate that both chaotic and periodic behavior is found as wheel parameters are changed in agreement with predictions from the Lorenz model. We furthermore show that when the measured angular velocity of our water wheel is used as an input signal to a computer model implementing the Lorenz equations, high quality chaos synchronization of the model and the water wheel is achieved. This indicates that the Lorenz equations provide a good description of the water wheel dynamics.Comment: 12 pages, 7 figures. The following article has been accepted by the American Journal of Physics. After it is published, it will be found at http://scitation.aip.org/ajp