The views of doctors in their first year of medical practice on the lasting impact of a preparation for house officer course they undertook as final year medical students

<p>Abstract</p> <p>Background</p> <p>The UK General Medical Council recommends that medical students have the opportunity of shadowing the outgoing new doctor whose post they will soon undertake. At the University of Nottingham the two-week shadowing period was preceded by two weeks of lectures/seminars wherein students followed sessions on topics such as common medical/surgical emergencies, contracts, time management, surviving the first two years of clinical practice, careers advice and so on.</p> <p>The present study aimed to gain a better knowledge and understanding of the lasting impact of a four-week preparation course for new Foundation Year 1 doctors [F1 s - interns]. The objectives chosen to achieve this aim were:</p> <p>1/ to determine the extent to which the lecture/seminar course and shadowing period achieved their stated aim of smoothing the transition from life as a medical student to work as a new doctor;</p> <p>2/ to evaluate perceptions of the importance of various forms of knowledge in easing the transition between medical student and new doctor</p> <p>Method</p> <p>In the spring of 2007, 90 graduates from Nottingham were randomly selected and then emailed a link to a short, online survey of quantitative and qualitative questions. Of these 76 responded. Analysis of quantitative data was carried out using SPSS 16.0 and employed McNemar's test. Analysis of the qualitative data was carried out using the constant comparative method.</p> <p>Results</p> <p>Only 31% of respondents strongly agreed or agreed that the lecture/seminar part of the course prepared them well for their first FY1 post; 14% agreed that during their first job they drew on the knowledge gained during the lecture/seminar course; 94% strongly agreed or agreed that the shadowing part of the course was more useful than the lecture/seminar part.</p> <p>Experiential knowledge gained in the shadowing was the most highly valued, followed by procedural knowledge with propositional knowledge coming far behind.</p> <p>Conclusions</p> <p>Our study shows that new doctors retrospectively value most the knowledge they are able to transfer to the workplace and value least material which seems to repeat what they had learned for their final exams.</p

The Doctrine of Piercing the Veil in an Era of Multiple Limited Liability Entities: An Opportunity to Codify the Test for Waiving Owners\u27 Limited Liability Protection

The use of the corporate form of business organization has always provided a firm\u27s owners/shareholders with a presumptive shield from personal liability for the debts of the business. Case-by-case exceptions to this limited-liability shield have developed in each state under the general rubric of “piercing the veil.” Courts and commentators alike have noted the vagueness of the piercing analysis and have questioned the appropriateness of some of the factors employed in that analysis. In addition, new forms of business entities, such as limited liability companies and limited liability partnerships, have been legislatively created over the past several decades, raising the issue of whether and by what standards their limited-liability shields will be pierced. This is an opportune time to reexamine the piercing doctrine and to provide a uniform standard for all forms of limited liability entities. The authors propose a Model Statute to replace the current common-law doctrine for determining when piercing will take place. Under the Model Statute, piercing is limited to situations in which the business owner (1) misrepresents the assets of the business, (2) engages in self-dealing transactions, or (3) takes assets from the business under circumstances that render the business insolvent. In the latter two situations, the owner\u27s liability is limited to the amount received by the owner in excess of the value given in return unless the owner knew or should have foreseen that the transfer would result in the insolvency of the business

Understanding the Effects of Repetitive Transcranial Magnetic Stimulation on Neuronal Circuits

Despite the widespread use of repetitive transcranial magnetic stimulation (rTMS) in both research and clinical settings, there is a paucity of evidence regarding the effects of its application on neural activity. Studies investigating the effects of rTMS on human participants (Huang et al., 2005) have shown that patterned trains of rTMS can be used to modulate the sensitivity of motor pathways for a period outlasting the stimulation itself. These changes are often attributed to an rTMS-induced increase in neural plasticity or a change in excitability of the motor pathway. Evidence that rTMS can modify the strength of motor pathways has led to its introduction into stroke rehabilitation research. It is hypothesized that post-stroke, rTMS can enhance plasticity induction within the brain and, when combined with manual therapy, can facilitate surviving neurons assuming the function of those lost to the stroke (Hsu et al., 2012). In practice however, despite a multitude of studies investigating this approach, there remains no convincing evidence that rTMS is capable of promoting sustained long-term improvement in recovery, above the effects of rehabilitation alone (Hsu et al., 2012; Lefaucheur et al., 2014). We are of the opinion that a lack of advancement within the field is due to an incomplete understanding of the effects of TMS on neural elements. Here we discuss some of the existing evidence and propose experimental approaches that may enhance the human application of rTMS

Are the times changing enough? Print media trends across four decades

Media analysis is an established area of sport sociology which has been documented by researchers systematically since the 1980s. Some trends have explored the differences between male and female athletes in the print media with significant evidence demonstrating that female athletes do not gain proportional representation and that many strategies employed by journalists traditionally seek to trivialise, sexualise and emphasise the female identity as ‘other’ rather than as athlete. This longitudinal study uniquely documents an analysis of a two week period in the British print media across four decades 1984-2014. This study, grounded in liberal feminism, presents both quantitative and qualitative data and the main quantitative results demonstrate that coverage for female athletes has decreased from 13% to 6.2%. Qualitative themes presented include: relationships, appearance, performance and nationality, the latter emerging as a new theme from the 2014 data set. The results demonstrate that there is little change in amount of representation afforded to female athletes but that there are reporting changes with a greater emphasis on performance and less reliance on appearance. The paper concludes with the position that although sports reporting, in general is on the increase, women athletes are being given less but potentially better coverage

Direct Confirmation of the Asymmetry of the Cas A Supernova with Light Echoes

We report the first detection of asymmetry in a supernova (SN) photosphere based on SN light echo (LE) spectra of Cas A from the different perspectives of dust concentrations on its LE ellipsoid. New LEs are reported based on difference images, and optical spectra of these LEs are analyzed and compared. After properly accounting for the effects of finite dust-filament extent and inclination, we find one field where the He I and H alpha features are blueshifted by an additional ~4000 km/s relative to other spectra and to the spectra of the Type IIb SN 1993J. That same direction does not show any shift relative to other Cas A LE spectra in the Ca II near-infrared triplet feature. We compare the perspectives of the Cas A LE dust concentrations with recent three-dimensional modeling of the SN remnant (SNR) and note that the location having the blueshifted He I and H alpha features is roughly in the direction of an Fe-rich outflow and in the opposite direction of the motion of the compact object at the center of the SNR. We conclude that Cas A was an intrinsically asymmetric SN. Future LE spectroscopy of this object, and of other historical SNe, will provide additional insight into the connection of explosion mechanism to SN to SNR, as well as give crucial observational evidence regarding how stars explode.Comment: 13 pages, 7 figures, accepted for publication in Ap

K Corrections For Type Ia Supernovae and a Test for Spatial Variation of the Hubble Constant

Cross-filter K corrections for a sample of "normal" Type Ia supernovae (SNe) have been calculated for a range of epochs. With appropriate filter choices, the combined statistical and systematic K correction dispersion of the full sample lies within 0.05 mag for redshifts z<0.7. This narrow dispersion of the calculated K correction allows the Type Ia to be used as a cosmological probe. We use the K corrections with observations of seven SNe at redshifts 0.3 < z <0.5 to bound the possible difference between the locally measured Hubble constant (H_L) and the true cosmological Hubble constant (H_0).Comment: 6 pages, 3 Postscript figures, uuencoded uses crckapb.sty and psfig.sty. To appear in Thermonuclear Supernovae (NATO ASI), eds. R. Canal, P. Ruiz-LaPuente, and J. Isern. Postscript version is also available at http://www-supernova.lbl.gov

Cosmology from Type Ia Supernovae

This presentation reports on first evidence for a low-mass-density/positive-cosmological-constant universe that will expand forever, based on observations of a set of 40 high-redshift supernovae. The experimental strategy, data sets, and analysis techniques are described. More extensive analyses of these results with some additional methods and data are presented in the more recent LBNL report #41801 (Perlmutter et al., 1998; accepted for publication in Ap.J.), astro-ph/9812133 . This Lawrence Berkeley National Laboratory reprint is a reduction of a poster presentation from the Cosmology Display Session #85 on 9 January 1998 at the American Astronomical Society meeting in Washington D.C. It is also available on the World Wide Web at http://supernova.LBL.gov/ This work has also been referenced in the literature by the pre-meeting abstract citation: Perlmutter et al., B.A.A.S., volume 29, page 1351 (1997).Comment: 9 pages, 8 color figs. Presented at Jan '98 AAS Meeting, also cited as BAAS,29,1351(1997). Archived here in response to requests; see more extensive analyses in ApJ paper (astro-ph/9812133

Implications For The Hubble Constant from the First Seven Supernovae at z >= 0.35

The Supernova Cosmology Project has discovered over twenty-eight supernovae (SNe) at 0.35 <z < 0.65 in an ongoing program that uses Type Ia SNe as high-redshift distance indicators. Here we present measurements of the ratio between the locally observed and global Hubble constants, H_0^L/H_0^G, based on the first 7 SNe of this high-redshift data set compared with 18 SNe at z <= 0.1 from the Calan/Tololo survey. If Omega_M <= 1, then light-curve-width corrected SN magnitudes yield H_0^L/H_0^G < 1.10 (95% confidence level) in both a Lambda=0 and a flat universe. The analysis using the SNe Ia as standard candles without a light-curve-width correction yields similar results. These results rule out the hypothesis that the discrepant ages of the Universe derived from globular clusters and recent measurements of the Hubble constant are attributable to a locally underdense bubble. Using the Cepheid-distance-calibrated absolute magnitudes for SNe Ia of Sandage (1996}, we can also measure the global Hubble constant, H_0^G. If Omega_M >= 0.2, we find that H_0^G < 70 km/s/Mpc in a Lambda=0 universe and H_0^G < 78 km/s/Mpc in a flat universe, correcting the distant and local SN apparent magnitudes for light curve width. Lower results for H_0^G are obtained if the magnitudes are not width corrected.Comment: 13 pages, 2 Postscript figures. Preprint also available at http://www-supernova.lbl.gov . To appear in ApJ Letter

Spectral Identification of an Ancient Supernova using Light Echoes in the LMC

We report the successful identification of the type of the supernova responsible for the supernova remnant SNR 0509-675 in the Large Magellanic Cloud (LMC) using Gemini spectra of surrounding light echoes. The ability to classify outbursts associated with centuries-old remnants provides a new window into several aspects of supernova research and is likely to be successful in providing new constraints on additional LMC supernovae as well as their historical counterparts in the Milky Way Galaxy (MWG). The combined spectrum of echo light from SNR 0509-675 shows broad emission and absorption lines consistent with a supernova (SN) spectrum. We create a spectral library consisting of 26 SNe Ia and 6 SN Ib/c that are time-integrated, dust-scattered by LMC dust, and reddened by the LMC and MWG. We fit these SN templates to the observed light echo spectrum using $\chi^2$ minimization as well as correlation techniques, and we find that overluminous 91T-like SNe Ia with \dm15<0.9 match the observed spectrum best.Comment: 12 pages, 18 Figures, to be published in Ap