Boosting clinical performance: The impact of enhanced final year placements.

BACKGROUND: This study follows on from a study that investigated how to develop effective final year medical student assistantship placements, using multidisciplinary clinical teams in planning and delivery. AIMS: This study assessed the effects on objective structured clinical examination (OSCE) performance of the in-course enhanced "super-assistantship" placement introduced to a randomly selected sample of 2013-14 final year medical students at Leeds medical school. METHODS: Quantitative data analysis was used to compare the global grades of OSCE stations between students who undertook this placement against those who did not. RESULTS: There was a small overall improvement in the "super-assistantship" student scores across the whole assessment (effect size = 0.085). "Pre-op Capacity", "Admissions Prescribing" and "Hip Pain" stations had small-medium effect sizes (0.226, 0.215, and 0.214) in favor of the intervention group. Other stations had small effect sizes (0.107-0.191), mostly in favor of the intervention group. CONCLUSIONS: The "super-assistantship" experience characterized by increasing student responsibility on placement can help to improve competence and confidence in clinical decision-making "in a simulated environment". The clinical environment and multidisciplinary team must be ready and supported to provide these opportunities effectively. Further in-course opportunities for increasing final year student responsibility should be developed

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

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

Partially-erupting prominences: a comparison between observations and model-predicted observables

<p><b>Aims:</b> We investigate several partially-erupting prominences to study their relationship with other CME-associated phenomena and compare these observations with observables predicted by a model of partially-expelled-flux-ropes (Gibson & Fan 2006a, ApJ, 637, L65; 2006b, J. Geophys. Res., 111, 12103).</p> <p><b>Methods:</b> We studied 6 selected events with partially-erupting prominences using multi-wavelength observations recorded by the Extreme-ultraviolet Imaging Telescope (EIT), Transition Region and Coronal Explorer (TRACE), Mauna Loa Solar Observatory (MLSO), Big Bear Solar Observatory (BBSO), and Soft X-ray Telescope (SXT). The observational features associated with partially-erupting prominences were then compared with the predicted observables from the model.</p> <p><b>Results:</b> The partially-expelled-flux-rope (PEFR) model can explain the partial eruption of these prominences, and in addition predicts a variety of other CME-related observables that provide evidence of internal reconnection during eruption. We find that all of the partially-erupting prominences studied in this paper exhibit indirect evidence of internal reconnection. Moreover, all cases showed evidence of at least one observable unique to the PEFR model, e.g., dimmings external to the source region and/or a soft X-ray cusp overlying a reformed sigmoid.</p> <p><b>Conclusions:</b> The PEFR model provides a plausible mechanism to explain the observed evolution of partially-erupting-prominence-associated CMEs in our study.</p&gt

Initiating undergraduate medical students into communities of research practise: what do supervisors recommend?

Abstract Background Much has been written in the educational literature on the value of communities of practise in enhancing student learning. Here, we take the experience of senior undergraduate medical students involved in short-term research as a member of a team as a paradigm for learning in a community of practise. Based on feedback from experienced supervisors, we offer recommendations for initiating students into the research culture of their team. In so doing, we endeavour to create a bridge between theory and practise through disseminating advice on good supervisory practise, where the supervisor is perceived as an educator responsible for designing the research process to optimize student learning. Methods Using the questionnaire design tool SurveyMonkey and comprehensive lists of contact details of staff who had supervised research projects at the University of Edinburgh during 1995 - 2008, current and previous supervisors were invited to recommend procedures which they had found successful in initiating students into the research culture of a team. Text responses were then coded in the form of derivative recommendations and categorized under general themes and sub-themes. Results Using the chi-square tests of linear trend and association, evidence was found for a positive trend towards more experienced supervisors offering responses (χ2 = 16.833, p 2 = 0.482, p = 0.487, n = 203), respectively. A total of 126 codes were extracted from the text responses of 65 respondents. These codes were simplified to form a complete list of 52 recommendations, which were in turn categorized under seven derivative overarching themes, the most highly represented themes being Connecting the student with others and Cultivating self-efficacy in research competence. Conclusions Through the design of a coding frame for supervisor responses, a wealth of ideas has been captured to make communities of research practise effective mediums for undergraduate student learning. The majority of these recommendations are underpinned by educational theory and have the potential to take the learner beyond the stage of initiation to that of integration within their community of research practise.</p

Undergraduate educational environment, perceived preparedness for postgraduate clinical training, and pass rate on the National Medical Licensure Examination in Japan

<p>Abstract</p> <p>Background</p> <p>We investigated the views of newly graduating physicians on their preparedness for postgraduate clinical training, and evaluated the relationship of preparedness with the educational environment and the pass rate on the National Medical Licensure Examination (NMLE).</p> <p>Methods</p> <p>Data were obtained from 2429 PGY-1 physicians-in-training (response rate, 36%) using a mailed cross-sectional survey. The Dundee Ready Education Environment Measure (DREEM) inventory was used to assess the learning environment at 80 Japanese medical schools. Preparedness was assessed based on 6 clinical areas related to the Association of American Medical Colleges Graduation Questionnaire.</p> <p>Results</p> <p>Only 17% of the physicians-in-training felt prepared in the area of general clinical skills, 29% in basic knowledge of diagnosis and management of common conditions, 48% in communication skills, 19% in skills associated with evidence-based medicine, 54% in professionalism, and 37% in basic skills required for a physical examination. There were substantial differences among the medical schools in the perceived preparedness of their graduates. Significant positive correlations were found between preparedness for all clinical areas and a better educational environment (all p < 0.01), but there were no significant associations between the pass rate on the NMLE and perceived preparedness for any clinical area, as well as pass rate and educational environment (all p > 0.05).</p> <p>Conclusion</p> <p>Different educational environments among universities may be partly responsible for the differences in perceived preparedness of medical students for postgraduate clinical training. This study also highlights the poor correlation between self-assessed preparedness for practice and the NMLE.</p

4pi Models of CMEs and ICMEs

Coronal mass ejections (CMEs), which dynamically connect the solar surface to the far reaches of interplanetary space, represent a major anifestation of solar activity. They are not only of principal interest but also play a pivotal role in the context of space weather predictions. The steady improvement of both numerical methods and computational resources during recent years has allowed for the creation of increasingly realistic models of interplanetary CMEs (ICMEs), which can now be compared to high-quality observational data from various space-bound missions. This review discusses existing models of CMEs, characterizing them by scientific aim and scope, CME initiation method, and physical effects included, thereby stressing the importance of fully 3-D ('4pi') spatial coverage.Comment: 14 pages plus references. Comments welcome. Accepted for publication in Solar Physics (SUN-360 topical issue

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

Adverse Events of Extracorporeal Ultrasound-Guided High Intensity Focused Ultrasound Therapy

High-intensity focused ultrasound (HIFU) is considered to be an alternative to surgery. Extracorporeal ultrasound-guided HIFU (USgFU) has been clinically used to treat solid tumors. Preliminary trials in a small sample of a Western population suggested that this modality was safe. Most trials are performed in China thereby providing comprehensive data for understanding the safety profile. The aim of this study was to evaluate adverse events of USgFU therapy.Clinical data were searched in 2 Chinese databases. Adverse events of USgFU were summarized and compared with those of magnetic resonance-guided HIFU (MRgFU; for uterine, bone or breast tumor) and transrectal ultrasound-guided HIFU (for prostate cancer or benign prostate hyperplasia). USgFU treatment was performed using 7 types of device. Side effects were evaluated in 13262 cases. There were fewer adverse events in benign lesions than in malignant lesions (11.81% vs. 21.65%, p<0.0001). Rates of adverse events greatly varied between the disease types (0-280%, p<0.0001) and between the applied HIFU devices in both malignant (10.58-44.38%, p<0.0001) and benign lesions (1.67-17.57%, p<0.0001). Chronological analysis did not demonstrate a decrease in the rate of adverse events. Based upon evaluable adverse events, incidences in USgFU were consistent with those in MRgFU or transrectal HIFU. Some side effects frequently occurred following transrectal HIFU were not reported in USgFU. Several events including intrahepatic metastasis, intraoperative high fever, and occlusions of the superior mesenteric artery should be of particular concern because they have not been previously noted. The types of adverse events suggested that they were ultrasonic lesions.The frequency of adverse events depended on the location of the lesion and the type of HIFU device; however, side effects of USgFU were not yet understood. USgFU did not decrease the incidence of adverse events compared with MRgFU