UK medical students' perceptions, attitudes, and interest toward medical leadership and clinician managers

Background: We aimed to determine UK medical students’ perceptions and attitudes and interest toward medical leadership and clinician managers. Methods: A cross-sectional study was conducted during the academic year 2015–2016. An online questionnaire was distributed to 2,349 final-year students from 10 UK medical schools. Participants were asked to complete a 5-point Likert scale on their current perceptions, attitudes, and interest toward medical leadership and clinician managers. They were also asked to self-rate their leadership competences set by the Medical Leadership Competency Framework and to rate the quality of management and leadership training they received from their medical school. Results: In total, we received 114 complete responses. Only 7.9% of respondents were in agreement (strongly agree or agree) when asked whether they felt they were well informed about what a managerial position in medicine entails. When asked whether clinicians should influence managerial decisions within a clinical setting, 94.7% of respondents were in agreement with the statement. About 85% of respondents were in agreement that it is important for clinicians to have managerial or leadership responsibilities, with 63.2% of students in agreement that they would have liked more management or leadership training during medical school. Over half the respondents rated their management and leadership training they received during medical school as “very poor” or “poor” (54.4%). Conclusion: Our study suggests that UK medical students have an appetite for management and leadership training and appreciate its importance but feel that the training they are receiving is poor. This suggests that there is a gap between the demand for management and leadership training and the quality of training supplied by UK medical schools

Routine provision of information on patient-reported outcome measures to healthcare providers and patients in clinical practice

This is the final version. Available from Cochrane Collaboration via the DOI in this record.This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the impact of the routine use of patient-reported outcomes (PROs) in clinical practice on the process of care (including patient-physician communication, professionals awareness of patients' quality of life, diagnosis and recognition rates, treatment rates, health services and resource use, as well as patient behaviour); patients' and professionals' experiences of care; and health outcomes (both generic and disease-specific, using both routinely-used clinical measures and PROs).Spanish Ministry of ScienceInnovation and the European commissionNational Institutes of Health Research (NIHR

Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits

A service evaluation of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing and result notification in patients attending a rapid testing service (Dean Street Express [DSE]) compared with those attending an existing ‘standard’ sexual health clinic (56 Dean Street [56DS]), and modelling the impact of the new service from 1 June 2014 to 31 May 2015. Primary outcome: time from patients’ sample collection to notification of test results at DSE compared with 56DS. Secondary outcomes estimated using a model: number of transmissions prevented and the number of new partner visits avoided and associated cost savings achieved due to rapid testing at DSE. In 2014/15, there were a total of 81,352 visits for CT/NG testing across 56DS (21,086) and DSE (60,266). Rapid testing resulted in a reduced mean time to notification of 8.68 days: 8.95 days for 56DS (95% CI 8.91–8.99) compared to 0.27 days for DSE (95% CI 0.26–0.28). Our model estimates that rapid testing at DSE would lead to 196 CT and/or NG transmissions prevented (2.5–97.5% centile range = 6–956) and lead to annual savings attributable to reduced numbers of partner attendances of £124,283 (2.5–97.5% centile range = £4260–590,331). DSE, a rapid testing service for asymptomatic infections, delivers faster time to result notification for CT and/or NG which enables faster treatment, reduces infectious periods and leads to fewer transmissions, partner attendances and clinic costs

Holography of Charged Dilaton Black Holes

We study charged dilaton black branes in $AdS_4$. Our system involves a dilaton $\phi$ coupled to a Maxwell field $F_{\mu\nu}$ with dilaton-dependent gauge coupling, ${1\over g^2} = f^2(\phi)$. First, we find the solutions for extremal and near extremal branes through a combination of analytical and numerical techniques. The near horizon geometries in the simplest cases, where $f(\phi) = e^{\alpha\phi}$, are Lifshitz-like, with a dynamical exponent $z$ determined by $\alpha$. The black hole thermodynamics varies in an interesting way with $\alpha$, but in all cases the entropy is vanishing and the specific heat is positive for the near extremal solutions. We then compute conductivity in these backgrounds. We find that somewhat surprisingly, the AC conductivity vanishes like $\omega^2$ at T=0 independent of $\alpha$. We also explore the charged black brane physics of several other classes of gauge-coupling functions $f(\phi)$. In addition to possible applications in AdS/CMT, the extremal black branes are of interest from the point of view of the attractor mechanism. The near horizon geometries for these branes are universal, independent of the asymptotic values of the moduli, and describe generic classes of endpoints for attractor flows which are different from $AdS_2\times R^2$.Comment: 33 pages, 3 figures, LaTex; v2, references added; v3, more refs added; v4, refs added, minor correction

DNA replication stress restricts ribosomal DNA copy number

Ribosomal RNAs (rRNAs) in budding yeast are encoded by ~100–200 repeats of a 9.1kb sequence arranged in tandem on chromosome XII, the ribosomal DNA (rDNA) locus. Copy number of rDNA repeat units in eukaryotic cells is maintained far in excess of the requirement for ribosome biogenesis. Despite the importance of the repeats for both ribosomal and non-ribosomal functions, it is currently not known how “normal” copy number is determined or maintained. To identify essential genes involved in the maintenance of rDNA copy number, we developed a droplet digital PCR based assay to measure rDNA copy number in yeast and used it to screen a yeast conditional temperature-sensitive mutant collection of essential genes. Our screen revealed that low rDNA copy number is associated with compromised DNA replication. Further, subculturing yeast under two separate conditions of DNA replication stress selected for a contraction of the rDNA array independent of the replication fork blocking protein, Fob1. Interestingly, cells with a contracted array grew better than their counterparts with normal copy number under conditions of DNA replication stress. Our data indicate that DNA replication stresses select for a smaller rDNA array. We speculate that this liberates scarce replication factors for use by the rest of the genome, which in turn helps cells complete DNA replication and continue to propagate. Interestingly, tumors from mini chromosome maintenance 2 (MCM2)-deficient mice also show a loss of rDNA repeats. Our data suggest that a reduction in rDNA copy number may indicate a history of DNA replication stress, and that rDNA array size could serve as a diagnostic marker for replication stress. Taken together, these data begin to suggest the selective pressures that combine to yield a “normal” rDNA copy number

Effective Holographic Theories for low-temperature condensed matter systems

The IR dynamics of effective holographic theories capturing the interplay between charge density and the leading relevant scalar operator at strong coupling are analyzed. Such theories are parameterized by two real exponents $(\gamma,\delta)$ that control the IR dynamics. By studying the thermodynamics, spectra and conductivities of several classes of charged dilatonic black hole solutions that include the charge density back reaction fully, the landscape of such theories in view of condensed matter applications is characterized. Several regions of the $(\gamma,\delta)$ plane can be excluded as the extremal solutions have unacceptable singularities. The classical solutions have generically zero entropy at zero temperature, except when $\gamma=\delta$ where the entropy at extremality is finite. The general scaling of DC resistivity with temperature at low temperature, and AC conductivity at low frequency and temperature across the whole $(\gamma,\delta)$ plane, is found. There is a codimension-one region where the DC resistivity is linear in the temperature. For massive carriers, it is shown that when the scalar operator is not the dilaton, the DC resistivity scales as the heat capacity (and entropy) for planar (3d) systems. Regions are identified where the theory at finite density is a Mott-like insulator at T=0. We also find that at low enough temperatures the entropy due to the charge carriers is generically larger than at zero charge density.Comment: (v3): Added discussion on the UV completion of the solutions, and on extremal spectra in the charged case. Expanded discusion on insulating extremal solutions. Many other refinements and corrections. 126 pages. 48 figure

Arterial versus venous lactate: a measure of sepsis in children.

This study assessed the agreement between arterial and venous blood lactate and pH levels in children with sepsis. This retrospective, three-year study involved 60 PICU patients, with data collected from electronic or paper patient records. The inclusion criteria comprised of children (≤17 years old) with sepsis and those who had a venous blood gas taken first with an arterial blood gas taken after within one hour. The lactate and pH values measured through each method were analysed. There is close agreement between venous and arterial lactate up to 2 mmol/L. As this value increases, this agreement becomes poor. The limits of agreement (LOA) are too large (±1.90 mmol/L) to allow venous and arterial lactate to be used interchangeably. The mean difference and LOA between both methods would be much smaller if derived using lactate values under 2.0 mmol/L. There is close agreement between arterial and venous pH (MD = -0.056, LOA ± 0.121). However, due to extreme variations in pH readings during sepsis, pH alone is an inadequate marker. CONCLUSION: A venous lactate ≤2 mmol/L can be used as a surrogate for arterial lactate during early management of sepsis in children. However, if the value exceeds 2 mmol/L, an arterial sample must confirm the venous result. What is known: • In children with septic shock, a blood gas is an important test to show the presence of acidosis and high lactic acid. Hyperlactataemia on admission is an early predictor of outcome and is associated with a greater mortality risk. • An arterial sample is the standard for lactate measurement, however getting a sample may be challenging in the emergency department or a general paediatric ward. Venous samples are quicker and easier to obtain. Adult studies generally advise caution in replacing venous lactate values for the arterial standard, whilst paediatric studies are limited in this area. What is new: • This is the first study assessing the agreement between arterial and peripheral venous lactate in children with sepsis, with a significant sample of patients. • This study shows that a venous sample with a lactate of ≤ 2 mmol/L can be used as a surrogate measurement for arterial lactate during early management of sepsis in children. However, if the venous lactate is above 2 mmol/L, an arterial sample must be taken to confirm the result

Knowledge Integration and Diffusion: Measures and Mapping of Diversity and Coherence

I present a framework based on the concepts of diversity and coherence for the analysis of knowledge integration and diffusion. Visualisations that help understand insights gained are also introduced. The key novelty offered by this framework compared to previous approaches is the inclusion of cognitive distance (or proximity) between the categories that characterise the body of knowledge under study. I briefly discuss the different methods to map the cognitive dimension

Supersymmetric Intersecting Branes on the Waves

We construct a general family of supersymmetric solutions in time- and space-dependent wave backgrounds in general supergravity theories describing single and intersecting p-branes embedded into time-dependent dilaton-gravity plane waves of an arbitrary (isotropic) profile, with the brane world-volume aligned parallel to the propagation direction of the wave. We discuss how many degrees of freedom we have in the solutions. We also propose that these solutions can be used to describe higher-dimensional time-dependent "black holes", and discuss their property briefly.Comment: 12 pages, LaTe

A holographic model for the fractional quantum Hall effect

Experimental data for fractional quantum Hall systems can to a large extent be explained by assuming the existence of a modular symmetry group commuting with the renormalization group flow and hence mapping different phases of two-dimensional electron gases into each other. Based on this insight, we construct a phenomenological holographic model which captures many features of the fractional quantum Hall effect. Using an SL(2,Z)-invariant Einstein-Maxwell-axio-dilaton theory capturing the important modular transformation properties of quantum Hall physics, we find dyonic diatonic black hole solutions which are gapped and have a Hall conductivity equal to the filling fraction, as expected for quantum Hall states. We also provide several technical results on the general behavior of the gauge field fluctuations around these dyonic dilatonic black hole solutions: We specify a sufficient criterion for IR normalizability of the fluctuations, demonstrate the preservation of the gap under the SL(2,Z) action, and prove that the singularity of the fluctuation problem in the presence of a magnetic field is an accessory singularity. We finish with a preliminary investigation of the possible IR scaling solutions of our model and some speculations on how they could be important for the observed universality of quantum Hall transitions.Comment: 86 pages, 16 figures; v.2 references added, typos fixed, improved discussion of ref. [39]; v.3 more references added and typos fixed, several statements clarified, v.4 version accepted for publication in JHE