Is it time for integration of surgical skills simulation into the United Kingdom undergraduate medical curriculum? A perspective from King’s College London School of Medicine

PURPOSE: Changes in undergraduate medical curricula, combined with reforms in postgraduate education, have training implications for surgical skills acquisition in a climate of reduced clinical exposure. Confidence and prior experience influences the educational impact of learning. Currently there is no basic surgical skills (BSS) programme integrated into undergraduate curricula in the United Kingdom. We explored the role of a dedicated BSS programme for undergraduates in improving confidence and influencing careers in King's College London School of Medicine, and the programme was evaluated. METHODS: A programme was designed in-line with the established Royal College of Surgeons course. Undergraduates were taught four key skills over four weeks: knot-tying, basic-suturing, tying-at-depth and chest-drain insertion, using low-fidelity bench-top models. A Likert-style questionnaire was designed to determine educational value and influence on career choice. Qualitative data was collected. RESULTS: Only 29% and 42% of students had undertaken previous practice in knot-tying and basic suturing, respectively. 96% agreed that skills exposure prior to starting surgical rotations was essential and felt a dedicated course would augment undergraduate training. There was a significant increase in confidence in the practice and knowledge of all skills taught (p<0.01), with a greater motivation to be actively involved in the surgical firm and theatres. CONCLUSION: A simple, structured BSS programme can increase the confidence and motivation of students. Early surgical skills targeting is valuable for students entering surgical, related allied, and even traditionally non-surgical specialties such as general practice. Such experience can increase the confidence of future junior doctors and trainees. We advocate the introduction of a BSS programme into United Kingdom undergraduate curricula

Ocean acidification and the loss of phenolic substances in marine plants.

Rising atmospheric CO(2) often triggers the production of plant phenolics, including many that serve as herbivore deterrents, digestion reducers, antimicrobials, or ultraviolet sunscreens. Such responses are predicted by popular models of plant defense, especially resource availability models which link carbon availability to phenolic biosynthesis. CO(2) availability is also increasing in the oceans, where anthropogenic emissions cause ocean acidification, decreasing seawater pH and shifting the carbonate system towards further CO(2) enrichment. Such conditions tend to increase seagrass productivity but may also increase rates of grazing on these marine plants. Here we show that high CO(2) / low pH conditions of OA decrease, rather than increase, concentrations of phenolic protective substances in seagrasses and eurysaline marine plants. We observed a loss of simple and polymeric phenolics in the seagrass Cymodocea nodosa near a volcanic CO(2) vent on the Island of Vulcano, Italy, where pH values decreased from 8.1 to 7.3 and pCO(2) concentrations increased ten-fold. We observed similar responses in two estuarine species, Ruppia maritima and Potamogeton perfoliatus, in in situ Free-Ocean-Carbon-Enrichment experiments conducted in tributaries of the Chesapeake Bay, USA. These responses are strikingly different than those exhibited by terrestrial plants. The loss of phenolic substances may explain the higher-than-usual rates of grazing observed near undersea CO(2) vents and suggests that ocean acidification may alter coastal carbon fluxes by affecting rates of decomposition, grazing, and disease. Our observations temper recent predictions that seagrasses would necessarily be "winners" in a high CO(2) world

Beyond Node Degree: Evaluating AS Topology Models

This is the accepted version of 'Beyond Node Degree: Evaluating AS Topology Models', archived originally at arXiv:0807.2023v1 [cs.NI] 13 July 2008.Many models have been proposed to generate Internet Autonomous System (AS) topologies, most of which make structural assumptions about the AS graph. In this paper we compare AS topology generation models with several observed AS topologies. In contrast to most previous works, we avoid making assumptions about which topological properties are important to characterize the AS topology. Our analysis shows that, although matching degree-based properties, the existing AS topology generation models fail to capture the complexity of the local interconnection structure between ASs. Furthermore, we use BGP data from multiple vantage points to show that additional measurement locations significantly affect local structure properties, such as clustering and node centrality. Degree-based properties, however, are not notably affected by additional measurements locations. These observations are particularly valid in the core. The shortcomings of AS topology generation models stems from an underestimation of the complexity of the connectivity in the core caused by inappropriate use of BGP data

Direct Instantons and Nucleon Magnetic Moments

We calculate the leading direct-instanton contributions to the operator product expansion of the nucleon correlator in a magnetic background field and set up improved QCD sum rules for the nucleon magnetic moments. Remarkably, the instanton contributions are found to affect only those sum rules which had previously been considered unstable. The new sum rules show good stability and reproduce the experimental values of the nucleon magnetic moments with values of $\chi$, the quark condensate magnetic susceptibility, consistent with other estimates.Comment: 15 pages, 2 figure

Diffuse Gamma Rays: Galactic and Extragalactic Diffuse Emission

"Diffuse" gamma rays consist of several components: truly diffuse emission from the interstellar medium, the extragalactic background, whose origin is not firmly established yet, and the contribution from unresolved and faint Galactic point sources. One approach to unravel these components is to study the diffuse emission from the interstellar medium, which traces the interactions of high energy particles with interstellar gas and radiation fields. Because of its origin such emission is potentially able to reveal much about the sources and propagation of cosmic rays. The extragalactic background, if reliably determined, can be used in cosmological and blazar studies. Studying the derived "average" spectrum of faint Galactic sources may be able to give a clue to the nature of the emitting objects.Comment: 32 pages, 28 figures, kapproc.cls. Chapter to the book "Cosmic Gamma-Ray Sources," to be published by Kluwer ASSL Series, Edited by K. S. Cheng and G. E. Romero. More details can be found at http://www.gamma.mpe-garching.mpg.de/~aws/aws.htm

Previous Experiences with Epilepsy and Effectiveness of Information to Change Public Perception of Epilepsy

Differences with regard to the effectiveness of health information and attitude change are suggested between people with direct, behavioral experiences with a health topic and people with indirect, nonbehavioral experiences. The effects of three different methods of health education about epilepsy, frequently used in health education practice, are assessed in a pretest posttest design with control groups, controlling for experiences with epilepsy. Subjects were 132 students from teacher-training colleges. After all treatments, attitudes, and knowledge about epilepsy were changed in a positive way. Treatments were found to be equally effective. Before treatment, direct behavioral experiences were related to knowledge and a more positive attitude towards epilepsy. After treatment, subjects with direct behavioral experiences with epilepsy showed less change of attitude and knowledge as compared with subjects with indirect experiences. Direct experiences appear to restrain the processing of new information and attitude change

Simultaneous determination of wave speed and arrival time of reflected waves using the pressure-velocity loop

This is the post print version of the article. The official published version can be found at the link below.In a previous paper we demonstrated that the linear portion of the pressure–velocity loop (PU-loop) corresponding to early systole could be used to calculate the local wave speed. In this paper we extend this work to show that determination of the time at which the PU-loop first deviates from linearity provides a convenient way to determine the arrival time of reflected waves (Tr). We also present a new technique using the PU-loop that allows for the determination of wave speed and Tr simultaneously. We measured pressure and flow in elastic tubes of different diameters, where a strong reflection site existed at known distances away form the measurement site. We also measured pressure and flow in the ascending aorta of 11 anaesthetised dogs where a strong reflection site was produced through total arterial occlusion at four different sites. Wave speed was determined from the initial slope of the PU-loop and Tr was determined using a new algorithm that detects the sampling point at which the initial linear part of the PU-loop deviates from linearity. The results of the new technique for detecting Tr were comparable to those determined using the foot-to-foot and wave intensity analysis methods. In elastic tubes Tr detected using the new algorithm was almost identical to that detected using wave intensity analysis and foot-to-foot methods with a maximum difference of 2%. Tr detected using the PU-loop in vivo highly correlated with that detected using wave intensity analysis (r 2 = 0.83, P < 0.001). We conclude that the new technique described in this paper offers a convenient and objective method for detecting Tr, and allows for the dynamic determination of wave speed and Tr, simultaneously

Quadratic Word Equations with Length Constraints, Counter Systems, and Presburger Arithmetic with Divisibility

Word equations are a crucial element in the theoretical foundation of constraint solving over strings, which have received a lot of attention in recent years. A word equation relates two words over string variables and constants. Its solution amounts to a function mapping variables to constant strings that equate the left and right hand sides of the equation. While the problem of solving word equations is decidable, the decidability of the problem of solving a word equation with a length constraint (i.e., a constraint relating the lengths of words in the word equation) has remained a long-standing open problem. In this paper, we focus on the subclass of quadratic word equations, i.e., in which each variable occurs at most twice. We first show that the length abstractions of solutions to quadratic word equations are in general not Presburger-definable. We then describe a class of counter systems with Presburger transition relations which capture the length abstraction of a quadratic word equation with regular constraints. We provide an encoding of the effect of a simple loop of the counter systems in the theory of existential Presburger Arithmetic with divisibility (PAD). Since PAD is decidable, we get a decision procedure for quadratic words equations with length constraints for which the associated counter system is \emph{flat} (i.e., all nodes belong to at most one cycle). We show a decidability result (in fact, also an NP algorithm with a PAD oracle) for a recently proposed NP-complete fragment of word equations called regular-oriented word equations, together with length constraints. Decidability holds when the constraints are additionally extended with regular constraints with a 1-weak control structure.Comment: 18 page

Diagnosis and Decision-Making in Telemedicine

This article provides an analysis of the skills that health professionals and patients employ in reaching diagnosis and decision-making in telemedicine consultations. As governmental priorities continue to emphasize patient involvement in the management of their disease, there is an increasing need to accurately capture the provider–patient interactions in clinical encounters. Drawing on conversation analysis of 10 video-mediated consultations in 3 National Health Service settings in England, this study examines the interaction between patients, General Practitioner (GPs), nurses, and consultants during diagnosis and decision-making, with the aim to identify the range of skills that participants use in the process and capture the interprofessional communication and patient involvement in the diagnosis and decision-making phases of telemedicine consultations. The analysis shows that teleconsultations enhance collaborative working among professionals and enable GPs and nurses to develop their skills and actively participate in diagnosis and decision-making by contributing primary care–specific knowledge to the consultation. However, interprofessional interaction may result in limited patient involvement in decisionmaking. The findings of this study can be used to inform training programs in telemedicine that focus on the development of effective skills for professionals and the provision of information to patients

Long-Term Visual Object Tracking Benchmark

We propose a new long video dataset (called Track Long and Prosper - TLP) and benchmark for single object tracking. The dataset consists of 50 HD videos from real world scenarios, encompassing a duration of over 400 minutes (676K frames), making it more than 20 folds larger in average duration per sequence and more than 8 folds larger in terms of total covered duration, as compared to existing generic datasets for visual tracking. The proposed dataset paves a way to suitably assess long term tracking performance and train better deep learning architectures (avoiding/reducing augmentation, which may not reflect real world behaviour). We benchmark the dataset on 17 state of the art trackers and rank them according to tracking accuracy and run time speeds. We further present thorough qualitative and quantitative evaluation highlighting the importance of long term aspect of tracking. Our most interesting observations are (a) existing short sequence benchmarks fail to bring out the inherent differences in tracking algorithms which widen up while tracking on long sequences and (b) the accuracy of trackers abruptly drops on challenging long sequences, suggesting the potential need of research efforts in the direction of long-term tracking.Comment: ACCV 2018 (Oral