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

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

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

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

Photoluminescence and photoluminescence excitation studies of lateral size effects in Zn_{1-x}Mn_xSe/ZnSe quantum disc samples of different radii

Quantum disc structures (with diameters of 200 nm and 100 nm) were prepared from a Zn_{0.72}Mn_{0.28}Se/ZnSe single quantum well structure by electron beam lithography followed by an etching procedure which combined dry and wet etching techniques. The quantum disc structures and the parent structure were studied by photoluminescence and photoluminescence excitation spectroscopy. For the light-hole excitons in the quantum well region, shifts of the energy positions are observed following fabrication of the discs, confirming that strain relaxation occurs in the pillars. The light-hole exciton lines also sharpen following disc fabrication: this is due to an interplay between strain effects (related to dislocations) and the lateral size of the discs. A further consequence of the small lateral sizes of the discs is that the intensity of the donor-bound exciton emission from the disc is found to decrease with the disc radius. These size-related effects occur before the disc radius is reduced to dimensions necessary for lateral quantum confinement to occur but will remain important when the discs are made small enough to be considered as quantum dots.Comment: LaTeX2e, 13 pages, 6 figures (epsfig

Chaotic Free-Space Laser Communication over Turbulent Channel

The dynamics of errors caused by atmospheric turbulence in a self-synchronizing chaos based communication system that stably transmits information over a $\sim$5 km free-space laser link is studied experimentally. Binary information is transmitted using a chaotic sequence of short-term pulses as carrier. The information signal slightly shifts the chaotic time position of each pulse depending on the information bit. We report the results of an experimental analysis of the atmospheric turbulence in the channel and the impact of turbulence on the Bit-Error-Rate (BER) performance of this chaos based communication system.Comment: 4 pages, 5 figure

The multi-component field topology of sunspot penumbrae - A diagnostic tool for spectropolarimetric measurements

Context: Sunspot penumbrae harbor highly structured magnetic fields and flows. The moving flux tube model offers an explanation for several observed phenomena, e.g. the Evershed effect and bright penumbral grains. Aims: A wealth of information can be extracted from spectropolarimetric observations. In order to deduce the structure of the magnetic field in sunspot penumbrae, detailed forward modeling is necessary. On the one hand, it gives insight into the sensitivity of various spectral lines to different physical scenarios. On the other hand, it is a very useful tool to guide inversion techniques. In this work, we present a generalized 3D geometrical model that embeds an arbitrarily shaped flux tube in a stratified magnetized atmosphere. Methods: The new semi-analytical geometric model serves as a frontend for a polarized radiative transfer code. The advantage of this model is that it preserves the discontinuities of the physical parameters across the flux tube boundaries. This is important for the detailed shape of the emerging Stokes Profiles and the resulting net circular polarization (NCP). Results: (a) The inclination of downflows in the outer penumbra must be shallower than approximately 15 degrees. (b) Observing the limb-side NCP of sunspots in the Fe I 1564.8 nm line offers a promising way to identify a reduced magnetic field strength in flow channels. (c) The choice of the background atmosphere can significantly influence the shape of the Stokes profiles, but does not change the global characteristics of the resulting NCP curves for the tested atmospheric models.Comment: 12 pages, 14 figure

High-intensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series

BACKGROUND: The use of minimally invasive ablative therapies in localised prostate cancer offer potential for a middle ground between active surveillance and radical therapy. METHODS: An analysis of men with organ-confined prostate cancer treated with transrectal whole-gland HIFU (Sonablate 500) between 1 February 2005 and 15 May 2007 was carried out in two centres. Outcome data (side-effects using validated patient questionnaires, biochemical, histology) were evaluated. RESULTS: A total of 172 men were treated under general anaesthetic as day-case procedures with 78% discharged a mean 5 h after treatment. Mean follow-up was 346 days (range 135-759 days). Urethral stricture was significantly lower in those with suprapubic catheter compared with urethral catheters (19.4 vs 40.4%, P = 0.005). Antibiotics were given to 23.8% of patients for presumed urinary tract infection and the rate of epididymitis was 7.6%. Potency was maintained in 70% by 12 months, whereas mild stress urinary incontinence (no pads) was reported in 7.0% (12 out of 172) with a further 0.6% (1 out of 172) requiring pads. There was no rectal toxicity and no recto-urethral fistulae. In all, 78.3% achieved a PSA nadir <= 0.5 mu g ml(-1) at 12 months, with 57.8% achieving <= 0.2 mu g ml(-1). Then, 8 out of 13 were retreated with HIFU, one had salvage external beam radiotherapy and four chose active surveillance for small-volume low-risk disease. Overall, there was no evidence of disease (PSA <0.5 mu g ml(-1) or negative biopsy if nadir not achieved) after one HIFU session in 92.4% ( 159 out of 172) of patients. CONCLUSION: HIFU is a minimally invasive, day-case ablative technique that can achieve good biochemical outcomes in the short term with minimal urinary incontinence and acceptable levels of erectile dysfunction. Long-term outcome needs further evaluation and the inception of an international registry for cases treated using HIFU will significantly aid this health technology assessment. British Journal of Cancer (2009) 101, 19-26. doi: 10.1038/sj.bjc.6605116 www.bjcancer.com Published online 9 June 2009 (C) 2009 Cancer Research U