The impact of due process and disruptions on emergency medicine education in the United States

INTRODUCTION: Academic Emergency Medicine (EM) departments are not immune to natural disasters, economic or political forces that disrupt a training program\u27s operations and educational mission. Due process concerns are closely intertwined with the challenges that program disruption brings. Due process is a protection whereby an individual will not lose rights without access to a fair procedural process. Effects of natural disasters similarly create disruptions in the physical structure of training programs that at times have led to the displacement of faculty and trainees. Variation exists in the implementation of transitions amongst training sites across the country, and its impact on residency programs, faculty, residents and medical students. METHODS: We reviewed the available literature regarding due process in emergency medicine. We also reviewed recent examples of training programs that underwent disruptions. We used this data to create a set of best practices regarding the handling of disruptions and due process in academic EM. RESULTS: Despite recommendations from organized medicine, there is currently no standard to protect due process rights for faculty in emergency medicine training programs. Especially at times of disruption, the due process rights of the faculty become relevant, as the multiple parties involved in a transition work together to protect the best interests of the faculty, program, residents and students. Amongst training sites across the country, there exist variations in the scope and impact of due process on residency programs, faculty, residents and medical students. CONCLUSION: We report on the current climate of due process for training programs, individual faculty, residents and medical students that may be affected by disruptions in management. We outline recommendations that hospitals, training programs, institutions and academic societies can implement to enhance due process and ensure the educational mission of a residency program is given due consideration during times of transition

Triple-Product Correlations in B -> V1 V2$ Decays and New Physics

In this paper we examine T-violating triple-product correlations (TP's) in B -> V1 V2 decays. TP's are excellent probes of physics beyond the standard model (SM) for two reasons: (i) within the SM, most TP's are expected to be tiny, and (ii) unlike direct CP asymmetries, TP's are not suppressed by the small strong phases which are expected in B decays. TP's are obtained via the angular analysis of B -> V1 V2. In a general analysis based on factorization, we demonstrate that the most promising decays for measuring TP's in the SM involve excited final-state vector mesons, and we provide estimates of such TP's. We find that there are only a handful of decays in which large TP's are possible, and the size of these TP's depends strongly on the size of nonfactorizable effects. We show that TP's which vanish in the SM can be very large in models with new physics. The measurement of a nonzero TP asymmetry in a decay where none is expected would specifically point to new physics involving large couplings to the right-handed b-quark.Comment: 42 pages, LaTeX, no figures. Title changed, several explanatory paragraphs added, references added, analysis and conclusions unchange

The Developmentally Regulated Expression of Twisted Gastrulation Reveals a Role for Bone Morphogenetic Proteins in the Control of T Cell Development

The evolutionarily conserved, secreted protein Twisted gastrulation (Tsg) modulates morphogenetic effects of decapentaplegic (dpp) and its orthologs, the bone morphogenetic proteins 2 and 4 (BMP2/4), in early Drosophila and vertebrate embryos. We have uncovered a role for Tsg at a much later stage of mammalian development, during T cell differentiation in the thymus. BMP4 is expressed by thymic stroma and inhibits the proliferation of CD4−CD8− double-negative (DN) thymocytes and their differentiation to the CD4+CD8+ double-positive (DP) stage in vitro. Tsg is expressed by thymocytes and up-regulated after T cell receptor signaling at two developmental checkpoints, the transition from the DN to the DP and from the DP to the CD4+ or CD8+ single-positive stage. Tsg can synergize with the BMP inhibitor chordin to block the BMP4-mediated inhibition of thymocyte proliferation and differentiation. These data suggest that the developmentally regulated expression of Tsg may allow thymocytes to temporarily withdraw from inhibitory BMP signals

Point-of-care tests for infectious diseases: barriers to implementation across three London teaching hospitals.

Existing Point-of-care tests (POCT) to help identify infection-related causes of illness can complement diagnostic and disposition decisions in children attending emergency departments.(1) Evidence-based clinical algorithms can integrate such POCT to aid in the admission and discharge decision process. Paediatric studies validating these tools are scarce, with very few studies conducted in UK centres.(2-5) POCT can be based on host infection markers (e.g. finger prick tests for C-reactive protein (CRP) to help decide if the patient has a bacterial or viral infection) or pathogen detection tests (e.g. throat/nose swabs to rapidly diagnose viral infections such as RSV or influenza). This article is protected by copyright. All rights reserved

Phase transitions in biological membranes

Native membranes of biological cells display melting transitions of their lipids at a temperature of 10-20 degrees below body temperature. Such transitions can be observed in various bacterial cells, in nerves, in cancer cells, but also in lung surfactant. It seems as if the presence of transitions slightly below physiological temperature is a generic property of most cells. They are important because they influence many physical properties of the membranes. At the transition temperature, membranes display a larger permeability that is accompanied by ion-channel-like phenomena even in the complete absence of proteins. Membranes are softer, which implies that phenomena such as endocytosis and exocytosis are facilitated. Mechanical signal propagation phenomena related to nerve pulses are strongly enhanced. The position of transitions can be affected by changes in temperature, pressure, pH and salt concentration or by the presence of anesthetics. Thus, even at physiological temperature, these transitions are of relevance. There position and thereby the physical properties of the membrane can be controlled by changes in the intensive thermodynamic variables. Here, we review some of the experimental findings and the thermodynamics that describes the control of the membrane function.Comment: 23 pages, 15 figure

A call to advance and translate research into policy on governance, ethics, and conflicts of interest in public health: the GECI-PH network

Efforts to adopt public health policies that would limit the consumption of unhealthy commodities, such as tobacco, alcohol and ultra-processed food products, are often undermined by private sector actors whose profits depend on the sales of such products. There is ample evidence showing that these corporations not only try to influence public health policy; they also shape research, practice and public opinion. Globalization, trade and investment agreements, and privatization, amongst other factors, have facilitated the growing influence of private sector actors on public health at both national and global levels. Protecting and promoting public health from the undue influence of private sector actors is thus an urgent task. With this backdrop in mind, we launched the “Governance, Ethics, and Conflicts of Interest in Public Health” Network (GECI-PH Network) in 2018. Our network seeks to share, collate, promote and foster knowledge on governance, ethical, and conflicts of interest that arise in the interactions between private sectors actors and those in public health, and within multi-stakeholder mechanisms where dividing lines between different actors are often blurred. We call for strong guidance to address and manage the influence of private sector actors on public health policy, research and practice, and for dialogue on this important topic. Our network recently reached 119 members. Membership is diverse in composition and expertise, location, and institutions. We invite colleagues with a common interest to join our network

Where constructionism and critical realism converge: interrogating the domain of epistemological relativism

The paper interrogates the status, nature and significance of epistemological relativism as a key element of constructionism and critical realism. It finds that epistemological relativism is espoused by authorities in critical realism and marginalized or displaced in the field of management and organization studies, resulting in forms of analysis that are empirically, but not fully critically, realist. This evaluation prompts reflection on the question of whether, how and with what implications epistemological relativism might be recast at the heart of critical realist studies of management and organization

The OSCE in a pre-registration osteopathy program: Introduction and psychometric properties

Objective To investigate the psychometric properties of the objective structured clinical examination (OSCE) conducted in the final year of a pre-professional osteopathy program. A variety of metrics are used to determine the reliability and validity of the examination. Methods Data from the OSCE conducted in 2011 was collated and analysed to establish the pass/fail rates, cost of the examination, internal consistency, and variance components. The examination was conducted over two days with students completing 5 stations on day 1 and 4 stations on day 2. Each station was of 15 min duration and there were 2 examiners per station. Results Forty-eight students and 31 examiners were involved in the examination. Twenty-six students failed at least one station with six students failing three or more stations. Cronbach's alpha was greater than 0.80 for all stations indicating that each is internally consistent and over 50% of the variance in the students' total score for a station was due to the students themselves. The total cost of conducting the examination was $AUD12,933.20. Conclusion The results of the study suggest that the OSCE format is an appropriate method for assessing clinical competency in osteopathic education. The OSCE should be used in conjunction with other forms of assessment to develop and overall picture of the students' clinical competency. Some modifications to the format of the assessment are required to improve the examination and these will be the subject of further studies

Exploding electron bubbles.

Electron bubbles, used in laboratories throughout the world for probing the unusual properties of liquid helium, can be made to explode by the application of negative pressure, according to investigations by Classen et al. published last month

Radical nostalgia, progressive patriotism and Labour's 'English problem'

‘Progressive patriots’ have long argued that Englishness can form the basis of a transformative political project, whether based on an historic tradition of resistance to state power or an open and cosmopolitan identity. However, this article suggests that the politics of Englishness present a number of specific dilemmas for Labour. First the historical narrative of a radical tradition in British history is not straightforwardly English and cannot easily be used to support a competitive politics of nationhood, in the way that disaffected English identifiers might desire. Second, the deliberately alternative nature of this ‘radical nostalgic’ narrative makes it an unlikely basis for a unifying national story. It is also at odds with Labour’s status as a successful party of government, committed to using the power of the British state, rather than opposing it. Finally, while ‘everyday Englishness’ may well align with core Labour values and be less socially conservative, intolerant or racially exclusive than it is often described, its very nature as an everyday practice, rather than a political identity makes it difficult for Labour to co-opt