Evaluating candidate reactions to selection practices using organisational justice theory

Objectives: This study aimed to examine candidate reactions to selection practices in postgraduate medical training using organisational justice theory. Methods: We carried out three independent cross-sectional studies using samples from three consecutive annual recruitment rounds. Data were gathered from candidates applying for entry into UK general practice (GP) training during 2007, 2008 and 2009. Participants completed an evaluation questionnaire immediately after the short-listing stage and after the selection centre (interview) stage. Participants were doctors applying for GP training in the UK. Main outcome measures were participants’ evaluations of the selection methods and perceptions of the overall fairness of each selection stage (short-listing and selection centre). Results: A total of 23 855 evaluation questionnaires were completed (6893 in 2007, 10 497 in 2008 and 6465 in 2009). Absolute levels of perceptions of fairness of all the selection methods at both the short-listing and selection centre stages were consistently high over the 3 years. Similarly, all selection methods were considered to be job-related by candidates. However, in general, candidates considered the selection centre stage to be significantly fairer than the short-listing stage. Of all the selection methods, the simulated patient consultation completed at the selection centre stage was rated as the most job-relevant. Conclusions: This is the first study to use a model of organisational justice theory to evaluate candidate reactions during selection into postgraduate specialty training. The high-fidelity selection methods are consistently viewed as more job-relevant and fairer by candidates. This has important implications for the design of recruitment systems for all specialties and, potentially, for medical school admissions. Using this approach, recruiters can systematically compare perceptions of the fairness and job relevance of various selection methods

Responding to Sea Level Rise: Does Short-Term Risk Reduction Inhibit Successful Long-Term Adaptation?

Most existing coastal climate-adaptation planning processes, and the research supporting them, tightly focus on how to use land use planning, policy tools, and infrastructure spending to reduce risks from rising seas and changing storm conditions. While central to community response to sea level rise, we argue that the exclusive nature of this focus biases against and delays decisions to take more discontinuous, yet proactive, actions to adapt—for example, relocation and aggressive individual protection investments. Public policies should anticipate real estate market responses to risk reduction to avoid large costs—social and financial—when and if sea level rise and other climate-related factors elevate the risks to such high levels that discontinuous responses become the least bad alternative

Dynamics of a two-level system strongly coupled to a high-frequency quantum oscillator

Recent experiments on quantum behavior in microfabricated solid-state systems suggest tantalizing connections to quantum optics. Several of these experiments address the prototypical problem of cavity quantum electrodynamics: a two-level system coupled to a quantum harmonic oscillator. Such devices may allow the exploration of parameter regimes outside the near-resonance and weak-coupling assumptions of the ubiquitous rotating-wave approximation (RWA), necessitating other theoretical approaches. One such approach is an adiabatic approximation in the limit that the oscillator frequency is much larger than the characteristic frequency of the two-level system. A derivation of the approximation is presented and the time evolution of the two-level-system occupation probability is calculated using both thermal- and coherent-state initial conditions for the oscillator. Closed-form evaluation of the time evolution in the weak-coupling limit provides insight into the differences between the thermal- and coherent-state models. Finally, potential experimental observations in solid-state systems, particularly the Cooper-pair box--nanomechanical resonator system, are discussed and found to be promising.Comment: 16 pages, 11 figures; revised abstract; some text revisions; added two figures and combined others; added references. Submitted to Phys. Rev.

1862-12-01 D.L. Irish requests a furlough

https://digitalmaine.com/cw_me_3rd_regiment_corr/1391/thumbnail.jp

Temporal and spatial dynamics of CO2 air-sea flux in the Gulf of Maine

Ocean surface layer carbon dioxide (CO2) data collected in the Gulf of Maine from 2004 to 2008 are presented. Monthly shipboard observations are combined with additional higher‐resolution CO2 observations to characterize CO2 fugacity ( fCO2) and CO2 flux over hourly to interannual time scales. Observed fCO2 andCO2 flux dynamics are dominated by a seasonal cycle, with a large spring influx of CO2 and a fall‐to‐winter efflux back to the atmosphere. The temporal results at inner, middle, and outer shelf locations are highly correlated, and observed spatial variability is generally small relative to the monthly to seasonal temporal changes. The averaged annual flux is in near balance and is a net source of carbon to the atmosphere over 5 years, with a value of +0.38 mol m−2 yr−1. However, moderate interannual variation is also observed, where years 2005 and 2007 represent cases of regional source (+0.71) and sink (−0.11) anomalies. We use moored daily CO2 measurements to quantify aliasing due to temporal undersampling, an important error budget term that is typically unresolved. The uncertainty of our derived annual flux measurement is ±0.26 mol m−2 yr−1 and is dominated by this aliasing term. Comparison of results to the neighboring Middle and South Atlantic Bight coastal shelf systems indicates that the Gulf of Maine exhibits a similar annual cycle and range of oceanic fCO2 magnitude but differs in the seasonal phase. It also differs by enhanced fCO2 controls by factors other than temperature‐driven solubility, including biological drawdown, fall‐to‐winter vertical mixing, and river runoff

Improving results of pediatric renal transplantation

BACKGROUND: Outcome after renal transplantation in children has been variable. We undertook a retrospective study of our experience over the past five years. STUDY DESIGN: From January 1, 1988, to October 15, 1992, 60 renal transplantations were performed upon 59 children at the Children's Hospital of Pittsburgh. Twenty-eight (47 percent) of the kidneys were from cadaveric donors, and 32 (53 percent) were from living donors. The recipients ranged in age from 0.8 to 17.4 years, with a mean of 9.8 ± 4.8 years. Forty-six (77 percent) recipients were undergoing a first transplant, while 14 (23 percent) received a second or third transplant. Eight (13 percent) of the patients were sensitized, with a panel reactive antibody of more than 40 percent. Eleven of the 14 patients undergoing retransplantation and seven of the eight patients who were sensitized received kidneys from cadaveric donors. Thirty- three (55 percent) patients received cyclosporine-based immunosuppression, and 27 (45 percent) received FK506 as the primary immunosuppressive agent. RESULTS: The median follow-up period was 36 months, with a range of six to 63 months. The one- and four-year actuarial patient survival rate was 100 and 98 percent. The one- and four-year actuarial graft survival rate was 98 and 83 percent. For living donor recipients, the one- and four-year actuarial patient survival rate was 100 and 100 percent; for cadaveric recipients, it was 100 and 96 percent. Corresponding one- and four-year actuarial graft survival rates were 100 and 95 percent for the living donor recipients and 96 and 69 percent for the cadaveric recipients. Patients on cyclosporine had a one- and four-year patient survival rate of 100 and 97 percent, and patients on FK506 had a one- and three-year patient survival rate of 100 and 100 percent. Corresponding one- and four-year actuarial graft survival rates were 100 and 85 percent in the cyclosporine group, while one- and three-year actuarial graft survival rates were 96 and 84 percent in the FK506 group. The mean serum creatinine level was 1.24 ± 0.64 mg per dL; the blood urea nitrogen level was 26 ± 13 mg per dL. The incidence of rejection was 47 percent; 75 percent of the rejections were steroid-responsive. The incidence of cytomegalovirus was 10 percent. The incidence of post-transplant lymphoproliferative disorder was 8 percent. None of the patients on cyclosporine were able to be taken off prednisone; 56 percent of the patients receiving FK506 were taken off prednisone successfully. Early growth and development data suggest that the patients receiving FK506 off prednisone had significant gains in growth. CONCLUSIONS: These results support the idea that renal transplantation is a successful therapy for end-stage renal disease in children. They also illustrate the potential benefits of a new immunosuppressive agent, FK506

New machine-marked tests for selection into core medical training: evidence from two validation studies

The objective of this study was to examine whether two machine-marked tests (MMTs), a clinical problem-solving test (CPS) and a situational judgement test (SJT, focusing on professional dilemmas), previously validated for selection into general practice (GP) training in the UK, could provide a valid selection methodology for shortlisting into core medical training (CMT). An exploratory longitudinal design was used to examine the psychometric properties of the MMTs for CMT applicants, and the correlation between MMT scores (time 1) and subsequent CMT interview outcomes (time 2). Independent samples from two consecutive years were used: in 2008 a retrospective analysis of data was used, while in 2009, doctors applying for CMT were asked to complete the MMTs for evaluation purposes. In 2008, a total of 1,711 doctors applied to both CMT and GP training and completed the MMTs. In 2009, a total of 2,265 doctors who applied for CMT completed the MMTs for evaluation purposes. The main outcome measure was the CMT applicants’ interview score. Both the CPS and SJT had good reliability and score distributions for 2008 and 2009 CMT samples, similar to the GP comparison samples. The MMTs were good predictors of performance in the CMT interviews (r0.56, p0.001 in 2008, and r0.61, p0.001 in 2009 for both MMTs combined) and offered incremental validity over the current shortlisting process. The GP MMTs offer an appropriate measurement methodology for selection into CMT, representing a significant innovation for developing selection methodology for CMT. Longer-term studies should be undertaken to assess the validity of all selection techniques used, in terms of CMT training outcome

FK506 IN PEDIATRIC KIDNEY-TRANSPLANTATION - PRIMARY AND RESCUE EXPERIENCE

Between December 14, 1989, and December 17, 1993,43 patients undergoing kidney transplantation alone at the Children’s Hospital of Pittsburgh received FK506 as the primary immunosuppressive agent. The mean recipient age was 10.2 ± 4.8 years (range 0.7–17.4), with 7 (16%) children under 5 years of age and 2 (5%) under 2 years of age. Fifteen (35%) children underwent retransplantation, and 5 (12%) had a panel reactive antibody level greater than 40%. Twenty-two (51%) cases were with cadaveric donors, and 21 (49%) were with living donors. The mean follow-up is 25 ± 14 months. There were no deaths. One and three year actuarial graft survival was 98% and 85%. The mean serum creatinine and BUN were 1.2 ± 0.6 mg/dl and 26 ± 11 mg/dl; the calculated creatinine clearance was 75 ± 23 ml/min/1.73 m(2). Twenty-four (62%) patients have been successfully withdrawn from steroids, and 24 (62%) require no anti-hypertensive medication. Improved growth was seen, particularly in pre-adolescent children off steroids. Between July 28, 1990, and December 2, 1993, 24 children were referred for rescue therapy with FK506, 14.6 ± 16.4 months (range 1.1–53.2) after transplantation. Nineteen (79%) were referred because of resistant rejection; 4 (17%) were referred because of proteinuria; 1 (4%) was switched because of steroid-related obesity. There were no deaths. One and two year graft survival was 75% and 68%. Seventeen (71%) patients were successfully rescued, including 1 of 2 patients who arrived on dialysis. Four (24%) of the successfully rescued patients were weaned off steroids. While not without side effects, which include nephrotoxicity, neurotoxicity, diabetogenicity, and viral complications, FK506 appears to be an effective immunosuppressive agent for both primary and rescue therapy after kidney transplantation. Its steroid-sparing qualities may be of particular importance in the pediatric population

An instrument to measure atmospheric pressure fluctuations above surface gravity waves

This paper describes an instrument which has been used successfully at a field site in the Bight of Abaco, Bahamas, to monitor the atmospheric pressure field above surface gravity waves in the frequency range .5 to 5. rad/s. The atmospheric pressure is sampled at fixed elevations with a cone-shaped probe having a pressure coefficient of less than .02 magnitude for angles of attack less than 15°; the probe is mounted on a vane to minimize horizontal angles of attack. The pressure signal is conducted to a subsurface transducer through a mercury-sealed bearing. Overall system noise is estimated to be of order .5 µbars and is largely wave-incoherent

A prospective randomized trial comparing sequential ganciclovir-high dose acyclovir to high dose acyclovir for prevention of cytomegalovirus disease in adult liver transplant recipients

Cytomegalovirus disease is an important cause of morbidity following liver transplantation. To date there has not been an effective prophylaxis for CMV disease after liver transplantation. One hundred forty-three patients were randomized to receive either high dose oral acyclovir (800 mg 4 times a day) alone for 3 months after transplantation (acyclovir group) or intravenous ganciclovir (5 mg/kg twice a day) for 14 days followed by high dose oral acyclovir to complete a 3-month regimen (ganciclovir group). Of 139 patients available for evaluation, 43 of 71 (61%) patients from the acyclovir group developed CMV infection compared with 16 of 68 (24%) from the ganciclovir group (relative risk, 3.69; 95% confidence interval, 2.07-6.56; PcO.OOOOl). Of those randomized, CMV disease was seen in 20 (28%) of the acyclovir group compared with 6 (9%) of the ganciclovir group (relative risk, 5.11; 95% confidence interval, 2.05-12.75; P=0.0001). The median time to onset of CMV infection was 45 days in the acyclovir group compared with 78 days in the ganciclovir group (P=0.004). The median time to onset of CMV disease was 40 days in the acyclovir group compared with 78 days in the ganciclovir patients (P=0.02). With respect to primary CMV infection, there was no difference in the rates in the 2 groups, but tissue invasive disease and recurrent CMV disease were less frequent in the ganciclovir group. It is concluded that a course of 2 weeks of ganciclovir immediately after transplantation followed by high dose oral acyclovir for 10 weeks is superior to a 12-week course of high dose oral acyclovir alone for prevention of both CMV infection and CMV disease after liver transplantation. However, the lack of significant effect in seronegative recipients who received grafts from seropositive donors suggests that other strategies are needed to prevent CMV infection in this high risk population. © 1994 by Williams & Wilkins