Twelve tips for conducting a virtual OSCE

Recently many medical schools have faced the challenge of redesigning their existing assessments to run in a virtual format. We ran a virtual Objective Structured Clinical Examination (OSCE) for a group of final year students assessing clinical communication skills, written communication, practical skills, examination skills and professionalism. OSCEs provide the opportunity to test skills that written papers cannot, so it was important to include such a clinical exam in the portfolio of assessments for graduating students. The virtual OSCE ran smoothly and was successful at discriminating between candidates. In this article, we share twelve practical tips from our experience and the small body of literature on how to successfully design and deliver a virtual OSCE. This format provides an opportunity to run similar assessments in the future if remote assessments or assessments of telemedicine skills are required

Charting self‐esteem during marital dissolution

Objective: The purpose of this study was to chart changes in self-esteem before and after marital dissolution to identify the factors that shape individuals' self-esteem during this life transition. Method: We analyzed 10 annual waves of self-esteem data from 291 divorcees from a nationally representative panel study of the Netherlands (N ~ 13,000). We charted the course of self-esteem before and after marital dissolution and tested a broad set of moderator variables that may shape individuals' self-esteem trajectories. Results: The average divorcee experienced significant decrease in self-esteem preceding marital dissolution and remained stable afterward. There were substantial individual differences in self-esteem trajectories, both before and after marital separation. Divorcees who experienced financial hardship, were affiliated with a church or religion, or scored low in Conscientiousness showed the most pronounced decrease in self-esteem during the years approaching marital dissolution. Conclusion: This study highlights the importance of assessing people multiple times before and after marital dissolution to dissect how people approach and respond to this life event. Results are consistent with perspectives that view divorce as an opportunity to abate the strains of an unhappy marriage

Charting self-esteem during marital dissolution.

ObjectiveThe purpose of this study was to chart changes in self-esteem before and after marital dissolution to identify the factors that shape individuals' self-esteem during this life transition.MethodWe analyzed 10 annual waves of self-esteem data from 291 divorcees from a nationally representative panel study of the Netherlands (N ~ 13,000). We charted the course of self-esteem before and after marital dissolution and tested a broad set of moderator variables that may shape individuals' self-esteem trajectories.ResultsThe average divorcee experienced significant decrease in self-esteem preceding marital dissolution and remained stable afterward. There were substantial individual differences in self-esteem trajectories, both before and after marital separation. Divorcees who experienced financial hardship, were affiliated with a church or religion, or scored low in Conscientiousness showed the most pronounced decrease in self-esteem during the years approaching marital dissolution.ConclusionThis study highlights the importance of assessing people multiple times before and after marital dissolution to dissect how people approach and respond to this life event. Results are consistent with perspectives that view divorce as an opportunity to abate the strains of an unhappy marriage

A randomised study of bolus vs continuous pump infusion of ifosfamide and doxorubicin with oral etoposide for small cell lung cancer.

One hundred and fifty-nine previously untreated patients with small cell lung cancer (SCLC), who were not eligible for intensive chemotherapy, were entered into a randomised study of intravenous (i.v.) doxorubicin and ifosfamide (with mesna) and oral etoposide. The i.v. drugs were given either by bolus therapy or by a continuous infusion (CI) pump over 7 days via a central venous line. Therapy was given for 6 weeks only. On weeks 1, 3 and 5 IV doxorubicin 35 mg m-2 was given with 5 days of oral etoposide 100 mg m-2 daily. On weeks 2, 4 and 6 IV ifosfamide 5 g m-2 was given with equidose mesna. The overall median survival was 25 weeks for patients in the bolus arm and 30 weeks for the CI therapy (P = 0.45). The overall response rate was 64% (18% complete response-CR) and 69% (30% CR) respectively (P = 0.13). The median WHO score for haematological toxicity was 4 for bolus therapy and 3 for CI therapy (P = 0.0007). Despite a trend for less supportive care for patients on CI therapy there were no significant differences in the use of i.v. antibodies and blood or platelet transfusions. There were fewer treatment delays due to myelotoxicity in the CI arm (P = 0.04). The median WHO score for non-haematological toxicity was 2 in both treatment groups. There was significantly less nausea (P = 0.037) but more mucositis (P = 0.01) in the CI arm. Weekly chemotherapy using CI treatment was as effective as bolus therapy. It was well accepted by patients. The assessment of quality of life in a subgroup of patients showed a statistically significant reduction in anxiety and depression for both groups of patients during therapy

A novel sputtering technique: Inductively Coupled Impulse Sputtering (ICIS)

Sputtering magnetic materials with magnetron based systems has the disadvantage of field quenching and variation of alloy composition with target erosion. The advantage of eliminating magnetic fields in the chamber is that this enables sputtered particles to move along the electric field more uniformly. Inductively coupled impulse sputtering (ICIS) is a form of high power impulse magnetron sputtering (HIPIMS) without a magnetic field where a high density plasma is produced by a high power radio frequency (RF) coil in order to sputter the target and ionise the metal vapour. In this emerging technology, the effects of power and pressure on the ionisation and deposition process are not known. The setup comprises of a 13.56 MHz pulsed RF coil pulsed with a duty cycle of 25 %. A pulsed DC voltage of 1900 V was applied to the cathode to attract Argon ions and initiate sputtering. Optical emission spectra (OES) for Cu and Ti neutrals and ions at constant pressure show a linear intensity increase for peak RF powers of 500 W – 3400 W and a steep drop of intensity for a power of 4500 W. Argon neutrals show a linear increase for powers of 500 W – 2300 W and a saturation of intensity between 2300 W – 4500 W. The influence of pressure on the process was studied at a constant peak RF power of 2300 W. With increasing pressure the ionisation degree increased. The microstructure of the coatings shows globular growth at 2.95×10−2 mbar and large-grain columnar growth at 1.2×10−1 mbar. Bottom coverage of unbiased vias with a width of 0.360 μm and aspect ratio of 2.5:1 increased from 15 % to 20 % for this pressure range. The current work has shown that the concept of combining a RF powered coil with a magnet-free high voltage pulsed DC powered cathode is feasible and produces very stable plasma. The experiments have shown a significant influence of power and pressure on the plasma and coating microstructure