Factors Influencing the Development of Practical Skills of Interns Working in Regional Hospitals of the Western Cape Province of South Africa.

Background: Clinical skills and the ability to perform procedures is a vital part of general medicine. Teaching these skills to aspiring doctors is a complex task. It starts with a good theoretical preparation and some practical experience at university. On graduating from university, each doctor is faced with the task of transforming theoretical knowledge into the practical, procedural skills of a competent professional. This study aims to assess the perceptions of intern doctors working in regional hospitals in the Western Cape of their skills training both at undergraduate level and during the intern year. Methods: Focus groups involving 25 interns with 11 months' experience from five regional hospitals were used. Six themes were identified. These were undergraduate training, the student's attitude, the intern's approach to learning skills, opportunities for interns in regional hospitals, backup and support, and personal growth in procedural skills. Results: The majority of the participants found that their training at medical school prepared them adequately for the intern year. An obstacle to skills training at university was the structure of the teaching tertiary hospital, with its emphasis on rare diseases and lack of opportunities for hands-on experience. The amount of skills that were learned at university was related to the enthusiasm of the student. Once the student had qualified and was employed in a regional hospital, opportunities to learn skills were available in excess. The benefit of doing an internship in a regional hospital was described as a fine balance between opportunities, responsibilities and backup. In all the focus groups, the interns remarked on the high level of responsibilities that they had to bear, but this spurred them on in the learning of skills. The relationship between intern and senior doctor was important when it came to learning procedures. In most hospitals, the junior doctors perceived the backup cover available to them as adequate. Consensus existed as to the value of such an intern year and its importance in gaining procedural skills. At the start of the year, most interns experienced a lack of confidence, together with a sense of fear that they might not be adequately prepared to do the work expected of them. Confidence seemed to grow as the year progressed, and this was linked to experience and the successful completion of procedures, as well as adequate backup. It was found that, by the end of the year, graduates from different universities with varying emphasis on practical skills all performed at a similar level. Conclusion: The findings of this study affirm the literature in suggesting that skills training at university needs to be standardised by the introduction of a core curriculum in procedural skills. Learning outcomes should be fashioned around the relevant competencies required in the pre-registration year. It is vital for the training of new doctors that the internship year be optimised in terms of opportunities and backup as part of a strategy to improve skills training. The value of regional hospitals in teaching junior doctors clinical skills is emphasised. South African Family Practice Vol. 50 (1) 2008: pp. 70-70

Objective and subjective measures of vergence step responses

AbstractDichoptic nonius lines are used for subjectively (psychophysically) measuring vergence states, but they have been questioned as valid indicators of vergence eye position. In a mirror-stereoscope, we presented convergent and divergent step-stimuli and estimated the vergence response with nonius lines flashed at fixed delays after the disparity step stimulus. For each delay, an adaptive psychophysical procedure was run to determine the physical nonius offset required for subjective alignment; these vergence states were compared with objective eye movement recordings. Between both measures of initial vergence, we calculated the maximal cross-correlation coefficient: the median in our sample was about 0.9 for convergence and divergence, suggesting a good agreement. Relative to the objective measures, the subjective method revealed a smaller vergence velocity and a larger vergence response in the final phase of the response, but both measures were well correlated. The dynamic nonius test is therefore considered to be useful to relatively evaluate a subject’s ability in disparity vergence

Electronic Structure of Three-Dimensional Superlattices Subject to Tilted Magnetic Fields

Full quantum-mechanical description of electrons moving in 3D structures with unidirectional periodic modulation subject to tilted magnetic fields requires an extensive numerical calculation. To understand magneto-oscillations in such systems it is in many cases sufficient to use the quasi-classical approach, in which the zero-magnetic-field Fermi surface is considered as a magnetic-field-independent rigid body in k-space and periods of oscillations are related to extremal cross-sections of the Fermi surface cut by planes perpendicular to the magnetic-field direction. We point out cases where the quasi-classical treatment fails and propose a simple tight-binding fully-quantum-mechanical model of the superlattice electronic structure.Comment: 8 pages, 7 figures, RevTex, submitted to Phys. Rev.

How do nutrient conditions and species identity influence the impact of mesograzers in eelgrass-epiphyte systems?

Coastal eutrophication is thought to cause excessive growth of epiphytes in eelgrass beds, threatening the health and survival of these ecologically and economically valuable ecosystems worldwide. Mesograzers, small crustacean and gastropod grazers, have the potential to prevent seagrass loss by grazing preferentially and efficiently on epiphytes. We tested the impact of three mesograzers on epiphyte biomass and eelgrass productivity under threefold enriched nutrient concentrations in experimental indoor mesocosm systems under summer conditions. We compared the results with earlier identical experiments that were performed under ambient nutrient supply. The isopod Idotea baltica, the periwinkle Littorina littorea, and the small gastropod Rissoa membranacea significantly reduced epiphyte load under high nutrient supply with Rissoa being the most efficient grazer, but only high densities of Littorina and Rissoa had a significant positive effect on eelgrass productivity. Although all mesograzers increased epiphyte ingestion with higher nutrient load, most likely as a functional response to the quantitatively and qualitatively better food supply, the promotion of eelgrass growth by Idotea and Rissoa was diminished compared to the study performed under ambient nutrient supply. Littorina maintained the level of its positive impact on eelgrass productivity regardless of nutrient concentrations

Cymantrene–Triazole "Click" Products: Structural Characterization and Electrochemical Properties

We report the first known examples of triazole-derivatized cymantrene complexes (η5-[4-substituted triazol-1-yl]cyclopentadienyl)tricarbonylmanganese(I), obtained via a “click” chemical synthesis, bearing a phenyl, 3-aminophenyl, or 4-aminophenyl moiety at the 4-position of the triazole ring. Structural characterization data using multinuclear NMR, UV–vis, ATR-IR, and mass spectrometric methods are provided, as well as crystallographic data for (η5-[4-phenyltriazol-1-yl]cyclopentadienyl)tricarbonylmanganese(I) and (η5-[4-(3-aminophenyl)triazol-1-yl]cyclopentadienyl)tricarbonylmanganese(I). Cyclic voltammetric characterization of the redox behavior of each of the three cymantrene–triazole complexes is presented together with digital simulations, in situ infrared spectroelectrochemistry, and DFT calculations to extract the associated kinetic and thermodynamic parameters. The trypanocidal activity of each cymantrene–triazole complex is also examined, and these complexes are found to be more active than cymantrene alone

Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study

Background: Adrenomedullin (ADM) regulates vascular tone and endothelial permeability during sepsis. Levels of circulating biologically active ADM (bio-ADM) show an inverse relationship with blood pressure and a direct relationship with vasopressor requirement. In the present prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock 1 (, AdrenOSS-1) study, we assessed relationships between circulating bio-ADM during the initial intensive care unit (ICU) stay and short-term outcome in order to eventually design a biomarker-guided randomized controlled trial. Methods: AdrenOSS-1 was a prospective observational multinational study. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use, and need for renal replacement therapy. AdrenOSS-1 included 583 patients admitted to the ICU with sepsis or septic shock. Results: Circulating bio-ADM levels were measured upon admission and at day 2. Median bio-ADM concentration upon admission was 80.5 pg/ml [IQR 41.5-148.1 pg/ml]. Initial SOFA score was 7 [IQR 5-10], and 28-day mortality was 22%. We found marked associations between bio-ADM upon admission and 28-day mortality (unadjusted standardized HR 2.3 [CI 1.9-2.9]; adjusted HR 1.6 [CI 1.1-2.5]) and between bio-ADM levels and SOFA score (p < 0.0001). Need of vasopressor/inotrope, renal replacement therapy, and positive fluid balance were more prevalent in patients with a bio-ADM > 70 pg/ml upon admission than in those with bio-ADM ≤ 70 pg/ml. In patients with bio-ADM > 70 pg/ml upon admission, decrease in bio-ADM below 70 pg/ml at day 2 was associated with recovery of organ function at day 7 and better 28-day outcome (9.5% mortality). By contrast, persistently elevated bio-ADM at day 2 was associated with prolonged organ dysfunction and high 28-day mortality (38.1% mortality, HR 4.9, 95% CI 2.5-9.8). Conclusions: AdrenOSS-1 shows that early levels and rapid changes in bio-ADM estimate short-term outcome in sepsis and septic shock. These data are the backbone of the design of the biomarker-guided AdrenOSS-2 trial. Trial registration: ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015

Grazer diversity effects in an eelgrass–epiphyte–microphytobenthos system

The dramatic loss of biodiversity and its consequences for ecosystem processes have been of considerable interest in recent ecological studies. However, the complex and interacting processes influencing diversity effects in multitrophic systems are still poorly understood. We used an experimental eelgrass system to study the effects of changing richness of three consumer species on the biomass, diversity and taxonomic composition of both epiphytic and benthic microalgal assemblages. After 1 week, consumer richness enhanced the grazing impact on epiphyte biomass relative to single consumer treatments and a positive effect of consumer richness on prey diversity was found. Moreover, strong effects of consumer species identity on taxonomic composition were found in both microalgal assemblages. However, the effects of consumer richness were not consistent over time. The consequences of high nutrient availability seemed to have masked consumer richness effects