Doctors who pilot the GMC's Tests of Competence: who volunteers and why?

Background: Doctors who are investigated by the General Medical Council (GMC) for performance concerns may be required to take a Test of Competence (ToC). The tests are piloted on volunteer doctors before they are used in Fitness to Practise (FtP) investigations. Objectives: To find out who volunteers to take a pilot ToC and why. Methods: This was a retrospective cohort study. Between February 2011 and October 2012 we asked doctors who volunteered for a test to complete a questionnaire about their reasons for volunteering and recruitment. We analysed the data using descriptive statistics and Pearson’s chi-square test. Results: 301 doctors completed the questionnaire. Doctors who took a ToC voluntarily were mostly women, of white ethnicity, of junior grades, working in general practice and who held a Primary Medical Qualification from the UK. This was a different population to doctors under investigation and all registered doctors in the UK. Most volunteers heard about the GMC’s pilot events through email from a colleague and used the experience to gain exam practice for forthcoming postgraduate exams. Conclusions: The reference group of volunteers are not representative of doctors under FtP investigation. Our findings will be used to inform future recruitment strategies with the aim to encourage better matching of groups who voluntarily pilot a ToC with those under FtP investigation

Serum vitamin D in patients with mild cognitive impairment and Alzheimer's disease

Objectives: To determine the relevance of Mini-Mental State Examination (MMSE), serum 25-hydroxyvitamin D (25(OH)D3), and 1,25(OH)2D3 concentrations to mild cognitive impairment (MCI) and various stages of Alzheimer's disease (AD). Materials and Methods: The study included 230 participants (>74 years) allocated to three main groups: 1-healthy subjects (HS, n = 61), 2-patients with MCI (n = 61), and 3- patients with Alzheimer's disease (AD) subdivided into three stages: mild (n = 41), moderate (n = 35), and severe AD (n = 32). The cognitive status was evaluated using MMSE. Serum 25 (OH)D3 (ng/ml) and 1,25(OH)2D3 concentrations (pg/ml) were determined by competitive radioimmunoassay. Results: MMSE scores and 25(OH)D3 were decreased in MCI and all stages of the AD in both genders. MMSE variability was due to gender in HS (11%) and to 25(OH)D3 in MCI (15%) and AD (26%). ROC analysis revealed an outstanding property of MMSE in diagnosis of MCI (AUC, 0.906; CI 95%, 0.847–0.965; sensitivity 82%; specificity, 98%) and AD (AUC, 0.997; CI 95%, 0.992–1; sensitivity, 100%; specificity, 98%). 25(OH)D3 exhibited good property in MCI (AUC, 0.765; CI 95%, 0.681–0.849; sensitivity, 90%; specificity, 54%) and an excellent property in diagnosis of AD (AUC, 0.843; CI 95%, 0.782–0.904; sensitivity, 97%; specificity, 79%). Logistic analyses revealed that, in MCI, MMSE could predict (or classify correctly) with 97.6% accuracy (Wald, 15.22, β, −0.162; SE, 0.554; OR = 0.115:0.039–0.341; p =.0001), whereas 25(OH)D3 with 80% accuracy (Wald, 41,013; β, −0.213; SE, 0.033; OR = 0.808: 0.757–863; p =.0001). 25(OH)D3 was the only significant predictor for the severe AD and contributed to MMSE variability. Age and gender were significant predictors only in the moderate AD. In patients with MCI, 25(OH)D3 and 1,25(OH)2D3 were correlated men, but in case of the AD, they were correlated in women. Conclusions: MMSE and serum 25(OH)D3 concentrations could be useful biomarkers for prediction and diagnosis of MCI and various stages of the AD. The results support the utility of vitamin D supplementation in AD therapy regimen. © 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc

How well do doctors think they perform on the General Medical Council's Tests of Competence pilot examinations? A cross-sectional study.

To investigate how accurately doctors estimated their performance on the General Medical Council's Tests of Competence pilot examinations

Effect of Copolymer Latexes on Physicomechanical Properties of Mortar Containing High Volume Fly Ash as a Replacement Material of Cement

© 2014 El-Sayed Negim et al. This paper investigates the physicomechanical properties of mortar containing high volume of fly ash (FA) as partial replacement of cement in presence of copolymer latexes. Portland cement (PC) was partially replaced with 0, 10, 20, 30 50, and 60% FA. Copolymer latexes were used based on 2-hydroxyethyl acrylate (2-HEA) and 2-hydroxymethylacrylate (2-HEMA). Testing included workability, setting time, absorption, chemically combined water content, compressive strength, and scanning electron microscopy (SEM). The addition of FA to mortar as replacement of PC affected the physicomechanical properties of mortar. As the content of FA in the concrete increased, the setting times (initial and final) were elongated. The results obtained at 28 days of curing indicate that the maximum properties of mortar occur at around 30% FA. Beyond 30% FA the properties of mortar reduce and at 60% FA the properties of mortar are lower than those of the reference mortar without FA. However, the addition of polymer latexes into mortar containing FA improved most of the physicomechanical properties of mortar at all curing times. Compressive strength, combined water, and workability of mortar containing FA premixed with latexes are higher than those of mortar containing FA without latexes.The authors gratefully acknowledge the funding provided by the European Union under the Marie Curie Action: International Incoming Fellowships (FP7-PEOPLE-2011-IIF), Grant agreement PIIF-GA-2011 (Project no. 300427) ProSeC for research on the production of sustainable self-compacting concrete.Published versio

Effect of Dispersions of Al2O3 on the Physical and Mechanical Properties of Pure Copper and Copper-Nickel Alloy

This paper illustrates the mechanical and physical properties of pure Cu and Cu-Ni (50-50 wt. %) alloy mixed with Al2O3 (1-4 wt. %) as micro-particles reinforcement materials. The attained composite alloy specimens\u27 characteristics were estimated such as microstructure, relative density, electrical and thermal conductivity, hardness, and compression yield stress properties to adjust the suitable optimum percentage of reinforcing material which has the best physical and mechanical properties with different main matrix materials whether pure Cu powder or Cu-Ni mechanical alloy. The micron-sized Al2O3 was added to enhance the mechanical and physical properties of the pure Cu and Cu-Ni alloy composites. The electrical and thermal conductivity for pure Cu alloy composites were improved compared to the copper-nickel alloy matrix composites material. The hardness and compression yield stress of pure copper has enhancement values and for Cu-Ni alloy composites have enhancement values and for Cu-Ni base composites, hardness and compression yield stress have improved with the most positive enhancement values

The Bismut-Elworthy-Li type formulae for stochastic differential equations with jumps

Consider jump-type stochastic differential equations with the drift, diffusion and jump terms. Logarithmic derivatives of densities for the solution process are studied, and the Bismut-Elworthy-Li type formulae can be obtained under the uniformly elliptic condition on the coefficients of the diffusion and jump terms. Our approach is based upon the Kolmogorov backward equation by making full use of the Markovian property of the process.Comment: 29 pages, to appear in Journal of Theoretical Probabilit

A computational model based on human performance for fluid management in critical care

Computational simulation is one of the most important ways of reproducing the dynamic responses of a Cyber Physical System using a model of the system. The simulation discovers areas of differential system performance and allows linking such performance back to system characteristics. In the medical domain, patient simulators are used to train physicians in patient management. One critical question is how to verify these systems under realistic human (physician) input. This requires the creation of realistic human models that would be able to capture human cognitive and decision abilities and limitations. Verification of such an overall physician-patient model would result in two advantages: (a) since physicians realistically would not give all possible inputs to the system, verification could be more efficient and (b) the verification may uncover areas of poor human performance. In this paper, we describe our methodology and results in creating a computational model of human fluid management in critical care, based on human experiments

Vascular Function and Handgrip Strength in Rheumatoid Arthritis Patients

Objective. To examine the relationship of handgrip strength with forearm blood flow (BF) and vascular resistance (VR) in rheumatoid arthritis (RA) patients. Methods. Forearm BF at rest (RBF) and after upper arm occlusion (RHBF), and handgrip strength were examined in 78 individuals (RA = 42 and controls (CT) = 36). Subsequently, VR at rest (RVR) and after occlusion (RHVR) were calculated. Results. The patients' RBF (P = 0.02) and RHBF (P = 0.0001) were less, whereas RVR (P = 0.002) and RHVR (P = 0.0001) were greater as compared to the CTs. Similarly, handgrip strength was lower in the RAs (P = 0.0001). Finally, handgrip strength was directly associated with RBF (r = 0.43; P = 0.0001), and RHBF (r = 0.5; P = 0.0001), and inversely related to RVR (r = −0.3; P = 0.009) and RHVR (r = −0.3; P = 0.007). Conclusion. The present study uniquely identifies an association between regional measures of forearm blood flow and handgrip strength in patients and healthy control. In addition, this study confirms the presence of vascular and muscle dysfunction in patients with rheumatoid arthritis, as evidenced by lower forearm blood flow indices, at rest and following occlusion, and lower handgrip strength as compared to healthy individuals