Early career choices and successful career progression in surgery in the UK: prospective cohort studies

<p>Abstract</p> <p>Background</p> <p>Changes to the structure of medical training worldwide require doctors to decide on their career specialty at an increasingly early stage after graduation. We studied trends in career choices for surgery, and the eventual career destinations, of UK graduates who declared an early preference for surgery.</p> <p>Methods</p> <p>Postal questionnaires were sent, at regular time intervals after qualification, to all medical qualifiers from all UK medical schools in selected qualification years between 1974 and 2005. They were sent in the first year after qualification, at year three and five years after qualification, and at longer time intervals thereafter.</p> <p>Results</p> <p>Responses were received from 27 749 of 38 280 doctors (73%) at year one, 23 468 of 33151 (71%) at year three, and 17 689 of 24 870 (71%) at year five. Early career preferences showed that surgery has become more popular over the past two decades. Looking forward from early career choice, 60% of respondents (64% of men, 48% of women) with a first preference for a surgical specialty at year one eventually worked in surgery (p < 0.001 for the male-female comparison). Looking backward from eventual career destinations, 90% of responders working in surgery had originally specified a first choice for a surgical specialty at year one. 'Match' rates between eventual destinations and early choices were much higher for surgery than for other specialties. Considering factors that influenced early specialty choice 'a great deal', comparing aspiring surgeons and aspiring general practitioners (GPs), a significantly higher percentage who chose surgery than general practice specified enthusiasm for the specialty (73% vs. 53%), a particular teacher or department (34% vs. 12%), inclinations before medical school (20% vs. 11%), and future financial prospects (24% vs. 13%); and a lower percentage specified that hours and working conditions had influenced their choice (21% vs. 71%). Women choosing surgery were influenced less than men by their inclinations before medical school or by their future financial prospects.</p> <p>Conclusions</p> <p>Surgery is a popular specialty choice in the UK. The great majority of doctors who progressed in a surgical career made an early and definitive decision to do so.</p

The role of laser interstitial thermal therapy in enhancing progression-free survival of difficult-to-access high-grade gliomas: A multicenter study

Surgical extent-of-resection has been shown to have an impact on high-grade glioma (HGG) outcomes; however, complete resection is rarely achievable in difficult-to-access (DTA) tumors. Controlled thermal damage to the tumor may have the same impact in DTA-HGGs. We report our multicenter results of laser interstitial thermal therapy (LITT) in DTA-HGGs. We retrospectively reviewed 34 consecutive DTA-HGG patients (24 glioblastoma, 10 anaplastic) who underwent LITT at Cleveland Clinic, Washington University, and Wake Forest University (May 2011–December 2012) using the NeuroBlate® System. The extent of thermal damage was determined using thermal damage threshold (TDT) lines: yellow TDT line (43°C for 2 min) and blue TDT line (43°C for 10 min). Volumetric analysis was performed to determine the extent-of-coverage of tumor volume by TDT lines. Patient outcomes were evaluated statistically. LITT was delivered as upfront in 19 and delivered as salvage in 16 cases. After 7.2 months of follow-up, 71% of cases demonstrated progression and 34% died. The median overall survival (OS) for the cohort was not reached; however, the 1-year estimate of OS was 68 ± 9%. Median progression-free survival (PFS) was 5.1 months. Thirteen cases who met the following two criteria—(1) <0.05 cm(3) tumor volume not covered by the yellow TDT line and (2) <1.5 cm(3) additional tumor volume not covered by the blue TDT line—had better PFS than the other 21 cases (9.7 vs. 4.6 months; P = 0.02). LITT can be used effectively for treatment of DTA-HGGs. More complete coverage of tumor by TDT lines improves PFS which can be translated as the extent of resection concept for surgery

Comparing distribution of harbour porpoise using generalized additive models and hierarchical Bayesian models with integrated nested laplace approximation

Species Distribution Models (SDMs) are used regularly to develop management strategies, but many modelling methods ignore the spatial nature of data. To address this, we compared fine-scale spatial distribution predictions of harbour porpoise (Phocoena phocoena) using empirical aerial-video-survey data collected along the east coast of Scotland in August and September 2010 and 2014. Incorporating environmental covariates that cover habitat preferences and prey proxies, we used a traditional (and commonly implemented) Generalized Additive Model (GAM), and two Hierarchical Bayesian Modelling (HBM) approaches using Integrated Nested Laplace Approxi�mation (INLA) model-fitting methodology. One HBM-INLA modelled gridded space (similar to the GAM), and the other dealt more explicitly in continuous space using a Log-Gaussian Cox Process (LGCP). Overall, predicted distributions in the three models were similar; however, HBMs had twice the level of certainty, showed much finer-scale patterns in porpoise distribution, and identified some areas of high relative density that were not apparent in the GAM. Spatial differences were due to how the two methods accounted for autocorrelation, spatial clustering of animals, and differences between modelling in discrete vs. continuous space; consequently, methods for spatial analyses likely depend on scale at which results, and certainty, are needed. For large-scale analysis (>5–10 km resolution, e.g. initial impact assessment), there was little difference be�tween results; however, insights into fine-scale (<1 km) distribution of porpoise from the HBM model using LGCP, while more computationally costly, offered potential benefits for refining conservation management or mitigation measures within offshore developments or protected areas

Word processing as an act of collaboration: description of a media artwork

As described in an earlier contribution to the JMP (Photography as an act of collaboration - Vol 15, Issue 3), my research explores the possibilities and implications of treating the camera and the photographic process as an active collaborator in the creation of scenes, events and ‘moments’ that did not exist until brought into being by the act of photographing them. The media artwork described here is the result of an experiment to explore the possibility of establishing a similarly collaborative relationship with the ‘agency’ of word-processing software that I have endeavoured to establish with the medium of photography. Despite comprehensively stripping the original text of both sense and sequence, the resulting text not only retains an uncanny degree of consistency with both the style and meaning of the original, but also reveals insights which had been only latent within the original. The result would appear to reinforce the findings of my previous research in photographic practice: that, by giving up conscious, rational control over the means of expression, we can (sometimes) create the conditions necessary for a constructive and often illuminating dialogue with the deus ex machina

Health impacts of flooding in Lewes: a comparison of reported gastrointestinal and other illness and mental health in flooded and non-flooded households

Severe flooding may become more frequent due to global warming. A historical cohort study was conducted by telephone interview for new episodes of illness in all age groups, and for psychological distress in adults, following severe river flooding on 12 October 2000 in the town of Lewes in Southern England. Two hundred and twenty-seven residents of 103 flooded households and 240 residents of 104 non-flooded households in the same postal district were recruited by random selection of addresses from a post flooding survey and a commercial database respectively. Having been flooded was associated with earache (RR 2.2 [1.1,4.1] p = 0.02), and a significant increase in risk of gastroenteritis with depth of flooding (RR 1.7 [0.9,3.0] p = 0.09, p for trend by flood depth = 0.04). Adults had a four-times higher risk of psychological distress defined as a score of > 4 in response to the 12- item General Health Questionnaire (GHQ-12) (RR 4.1 [2.6, 6.4] p < 0.0005, p for trend by flood depth = 0.01). Associations between flooding and new episodes of physical illness in adults diminished after adjustment for psychological distress. Flooding remained highly significantly associated with psychological distress after adjustment for physical illnesses. Psychological distress may explain some of the excess physical illness reported by flooded adults and possibly by children as well. Policies to promote population resilience to flooding where flood prevention has failed must include practical support for flood victims and provision of appropriate psychological support. Associations with physical illnesses affirm the need for advice and assistance with individual, household and environmental hygiene and access to medical services

Spatiotemporal variation in harbor porpoise distribution and foraging across a landscape of fear

Understanding spatiotemporally varying animal distributions can inform ecological understanding of species' behavior (e.g., foraging and predator/prey interactions) and support development of management and conservation measures. Data from an array of echolocation‐click detectors (C‐PODs) were analyzed using Bayesian spatiotemporal modeling to investigate spatial and temporal variation in occurrence and foraging activity of harbor porpoises (Phocoena phocoena) and how this variation was influenced by daylight and presence of bottlenose dolphins (Tursiops truncatus). The probability of occurrence of porpoises was highest on an offshore sandbank, where the proportion of detections with foraging clicks was relatively low. The porpoises' overall distribution shifted throughout the summer and autumn, likely influenced by seasonal prey availability. Probability of porpoise occurrence was lowest in areas close to the coast, where dolphin detections were highest and declined prior to dolphin detection, leading potentially to avoidance of spatiotemporal overlap between porpoises and dolphins. Increased understanding of porpoises' seasonal distribution, key foraging areas, and their relationship with competitors can shed light on management options and potential interactions with offshore industries

Mobilising Knowledge through Global Partnerships to Support Research-informed Teaching: Five Models for Translational Research

Education Futures Collaboration Charity The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Improving the quality of teaching is of global concern: UNESCO’s Sustainable Development Goal (SDG) 4c in the Education 2030: Framework for Action calls for high quality teaching for all. The OECD challenges the education system to improve Knowledge Management. JET’s (2015) special issue: Translational Research (TR) and Knowledge Mobilisation in Teacher Education introduced the concept of ‘translational’ or ‘theory to practice’ research - well-established in medicine but not in education. Five TR models were subsequently developed by the MESH charity’s international network with organisations in South Africa, Bangladesh, Australia, Pakistan, UK. These distinct models engage 1) university staff and teachers 2) subject associations, 3) research units, 4) an international NGO working in crisis settings, 5) PhD tutors and students. Each model shares common features forming the MESH Translational Research methodology introduced in this article. A TR repository is part of the MESH knowledge mobilisation strategy giving teachers access to research summaries which, overtime, accumulate knowledge. TR publications called MESHGuides (www.meshguides.org) complement existing forms of publication. This article proposes the MESH TR methodology as one affordable and scalable solution to OECD and UNESCO’s challenges of keeping teachers up-to-date and making new knowledge accessible to teachers regardless of location

Big Data Analytics for Earth Sciences: the EarthServer approach

Big Data Analytics is an emerging field since massive storage and computing capabilities have been made available by advanced e-infrastructures. Earth and Environmental sciences are likely to benefit from Big Data Analytics techniques supporting the processing of the large number of Earth Observation datasets currently acquired and generated through observations and simulations. However, Earth Science data and applications present specificities in terms of relevance of the geospatial information, wide heterogeneity of data models and formats, and complexity of processing. Therefore, Big Earth Data Analytics requires specifically tailored techniques and tools. The EarthServer Big Earth Data Analytics engine offers a solution for coverage-type datasets, built around a high performance array database technology, and the adoption and enhancement of standards for service interaction (OGC WCS and WCPS). The EarthServer solution, led by the collection of requirements from scientific communities and international initiatives, provides a holistic approach that ranges from query languages and scalability up to mobile access and visualization. The result is demonstrated and validated through the development of lighthouse applications in the Marine, Geology, Atmospheric, Planetary and Cryospheric science domains