Construct-level predictive validity of educational attainment and intellectual aptitude tests in medical student selection: meta-regression of six UK longitudinal studies

Background: Measures used for medical student selection should predict future performance during training. A problem for any selection study is that predictor-outcome correlations are known only in those who have been selected, whereas selectors need to know how measures would predict in the entire pool of applicants. That problem of interpretation can be solved by calculating construct-level predictive validity, an estimate of true predictor-outcome correlation across the range of applicant abilities. Methods: Construct-level predictive validities were calculated in six cohort studies of medical student selection and training (student entry, 1972 to 2009) for a range of predictors, including A-levels, General Certificates of Secondary Education (GCSEs)/O-levels, and aptitude tests (AH5 and UK Clinical Aptitude Test (UKCAT)). Outcomes included undergraduate basic medical science and finals assessments, as well as postgraduate measures of Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) performance and entry in the Specialist Register. Construct-level predictive validity was calculated with the method of Hunter, Schmidt and Le (2006), adapted to correct for right-censorship of examination results due to grade inflation. Results: Meta-regression analyzed 57 separate predictor-outcome correlations (POCs) and construct-level predictive validities (CLPVs). Mean CLPVs are substantially higher (.450) than mean POCs (.171). Mean CLPVs for first-year examinations, were high for A-levels (.809; CI: .501 to .935), and lower for GCSEs/O-levels (.332; CI: .024 to .583) and UKCAT (mean = .245; CI: .207 to .276). A-levels had higher CLPVs for all undergraduate and postgraduate assessments than did GCSEs/O-levels and intellectual aptitude tests. CLPVs of educational attainment measures decline somewhat during training, but continue to predict postgraduate performance. Intellectual aptitude tests have lower CLPVs than A-levels or GCSEs/O-levels. Conclusions: Educational attainment has strong CLPVs for undergraduate and postgraduate performance, accounting for perhaps 65% of true variance in first year performance. Such CLPVs justify the use of educational attainment measure in selection, but also raise a key theoretical question concerning the remaining 35% of variance (and measurement error, range restriction and right-censorship have been taken into account). Just as in astrophysics, ‘dark matter’ and ‘dark energy’ are posited to balance various theoretical equations, so medical student selection must also have its ‘dark variance’, whose nature is not yet properly characterized, but explains a third of the variation in performance during training. Some variance probably relates to factors which are unpredictable at selection, such as illness or other life events, but some is probably also associated with factors such as personality, motivation or study skills

Strongman training – Needs analysis and integration into strength and conditioning programming: part 2.

The article aims to evaluate the integration of strongman based exercises within the practice of strength and conditioning. It should give the reader a clear understanding of the specific physiological and biomechanical traits of each of the exercises discussed in the previous article. This information will then be used to discuss its amalgamation within traditional based exercises within the planning of a periodised programme for strength and conditioning practitioners

Strongman training – a rationale for its inclusion in strength & conditioning: part 1

This article, the first in a two-part series, aims to introduce the concepts of strongman-type training relative to some of the exercises adopted. It should give the reader a detailed background into the evolution of strongman training with a strong rationale for its inclusion within the practice of strength and conditioning

Association between body mass index and mental health among Scottish adult population: a cross-sectional study of 37,272 participants

<b>Background:</b> The evidence is conflicting as to whether body mass index (BMI) is associated with mental health and, if so, to what extent it varies by sex and age. We studied mental health across the full spectrum of BMI among the general population, and conducted subgroup analyses by sex and age.<p></p> <b>Method:</b> We undertook a cross-sectional study of a representative sample of the Scottish adult population. The Scottish Health Survey provided data on mental health, measured by the General Health Questionnaire-12 (GHQ), BMI, demographic and life-style information. Good mental health was defined as a GHQ score <4, and poor mental health as a GHQ score ≥4. Logistic regression models were applied. Results Of the 37 272 participants, 5739 (15.4%) had poor mental health. Overall, overweight participants had better mental health than the normal-weight group [adjusted odds ratio (OR) 0.93, 95% confidence interval (CI) 0.87–0.99, p = 0.049], and individuals who were underweight, class II or class III obese had poorer mental health (class III obese group: adjusted OR 1.26, 95% CI 1.05–1.51, p = 0.013). There were significant interactions of BMI with sex (p = 0.013) and with age (p < 0.001). Being overweight was associated with significantly better mental health in middle-aged men only. In contrast, being underweight at all ages or obese at a young age was associated with significantly poorer mental health in women only.<p></p> <b>Conclusions:</b> The adverse associations between adiposity and mental health are specific to women. Underweight women and young women who are obese have poorer mental health. In contrast, middle-aged overweight men have better mental health.<p></p&gt

Shear-free, Irrotational, Geodesic, Anisotropic Fluid Cosmologies

General relativistic anisotropic fluid models whose fluid flow lines form a shear-free, irrotational, geodesic timelike congruence are examined. These models are of Petrov type D, and are assumed to have zero heat flux and an anisotropic stress tensor that possesses two distinct non-zero eigenvalues. Some general results concerning the form of the metric and the stress-tensor for these models are established. Furthermore, if the energy density and the isotropic pressure, as measured by a comoving observer, satisfy an equation of state of the form $p = p(\mu)$, with $\frac{dp}{d\mu} \neq -\frac{1}{3}$, then these spacetimes admit a foliation by spacelike hypersurfaces of constant Ricci scalar. In addition, models for which both the energy density and the anisotropic pressures only depend on time are investigated; both spatially homogeneous and spatially inhomogeneous models are found. A classification of these models is undertaken. Also, a particular class of anisotropic fluid models which are simple generalizations of the homogeneous isotropic cosmological models is studied.Comment: 13 pages LaTe

A 4-week resistance training intervention improves stability, strength and neuromuscular activity in the lower limb: a case study of a cerebral palsy adult

Spastic diplegia, a form of cerebral palsy, is a neurological disorder that results in some degree of spasticity. It is often associated with impairment of both normal and selective movement of the lower limbs, and some degree of muscular weakness. Resistance training is an established exercise intervention with numerous neurological benefits. Evidence suggests that resistance training can positively improve stability in young populations with cerebral palsy. However, little research exists in adult populations, who are at greater risk of inactivity due to ageing and an increase in sedentarism. A single-subject (aged 35-years old, 150.5 centimetres, 81 kilograms) case-study was therefore carried out to investigate the effectiveness of a 4-week resistance training intervention on stability, neuromuscular activity and force output in a male adult with cerebral palsy. The variables measured were total centre of pressure displacement, peak torque in both the quadriceps and hamstrings and Surface Electromyography (sEMG) activity in the Rectus Femoris (RF), Vastus Lateralis (VL), Biceps Femoris (BF) and Semitendinosus (ST). The results demonstrated that a 4-week resistance training intervention reduced total centre of pressure displacement (-51.34%) whilst concomitantly increased sEMG output (RF left +80% right +22%, VL left +160% right +26%, BF left +203% right +44%, ST left +40% right +90%) and peak torque values (right leg extension -7%, right leg flexion +29%, left leg extension +11%, left leg flexion +42%). In conclusion, this case study demonstrates that a 4-week resistance training intervention improves the stability of the participant, possibly through neurological adaptations and improvements to lower limb strength

Resilience Management: A Framework for Assessing and Improving the Resilience of Organisations

Resilient Organisations Research Report 2007/01Organisations today are increasingly aware of the need to prepare for the unexpected. High profile international events of the last decade, such as the September 11th terrorist attacks, the Indian Ocean tsunami, Hurricane Katrina and the emerging threat of a pandemic all serve to remind organisations that the unimaginable can and does happen. Stories emerge from these events of organisations that survived or failed; at first glance there does not appear to be a particular pattern. Some survivors had excellent disaster response plans in place; others had none, surviving purely on the merits of strong leadership and the commitment and determination of staff. Many organisations that are devastated simply never reopen again; others evolve so radically that they are hard to recognise from their pre-crisis form. This research project seeks to explore what it is that makes some organisations more able to survive a major crisis than others, and suggests a framework for both evaluating and improving the resilience of individual organisations

Controls on trace metal authigenic enrichment in reducing sediments: insights from modern oxygen-deficient settings

Any effort to reconstruct Earth history using variations in authigenic enrichments of redox-sensitive and biogeochemically important trace metals must rest on a fundamental understanding of their modern oceanic and sedimentary geochemistry. Further, unravelling the multiple controls on sedimentary enrichments requires a multi-element approach. Of the range of metals studied, most is known about the behavior of Fe, Mn, and Mo. In this study, we compare the authigenic enrichment patterns of these elements with a group whose behavior is not as well defined (Cd, Cu, Zn, and Ni) in three oxygen-poor settings: the Black Sea, the Cariaco Basin (Venezuela), and the Peru Margin. These three settings span a range of biogeochemical environments, allowing us to isolate the different controls on sedimentary enrichment. Our approach, relying on the covariation of elemental enrichment factors [EF, defined for element X as: EFX = (X/Al)sample/(X/Al)lithogenic], has previously been applied to Mo and U to elucidate paleoenvironmental information on, for example, benthic redox conditions, the particulate shuttle, and the evolution of water mass chemistry. We find two key controls on trace metal enrichment. First, the concentration of an element in the lithogenic background sediment (used in calculating EFX) controls the magnitude of potential enrichment. Maximum enrichment factors of 376 and 800 are calculated for Mo (∼1 ppm in detrital sediments) and Cd (∼0.3 ppm), respectively, compared to values not greater than 17 in any setting for the other five metals (∼45 ppm to ∼4.5 wt.% in detrital sediments). Second, there is a relationship between the aqueous concentration of the element in overlying seawater and its degree of enrichment in the sediment. We further identify four important processes for delivery of trace metals to the sediment. These are: (1) cellular uptake (especially important for Zn and Cd), (2) interaction/co-precipitation with sulfide (Mo, Cu, and Cd), (3) passive scavenging via the traditional particulate shuttle (Mo, Ni, and Cu), and (4) an association with the benthic Fe redox shuttle (Mn, Ni). Finally, we summarize the oceanic mass balance of Cd and Mo and place the first constraints on the contribution of reducing sediments to the oceanic mass balance of Cu, Zn, and Ni. We show that reducing sediments are the ultimate repository for up to half the total output flux of these elements from the oceanic dissolved pool

Accuracy and Coverage of Using the Assigned International Classification of Diseases, 9th and 10th Revision, Clinical Modification Codes for Detecting Bleeding Events in Electronic Health Record

Background: Hemorrhages are common events that confer significant risk for in-hospital and post-discharge morbidity and mortality among cardiovascular disease (CVD) patients treated with anticoagulation. International Classification of Diseases, 9th and 10th Revision, Clinical Modification (ICD-9-CM, ICD-10-CM) codes have been widely used in CVD research and managements. Objective: To determine the accuracy and coverage of assigned ICD-CM codes for reporting bleeding events. Methods: From the University of Massachusetts Medical School electronic health record (EHR) database we identified 21k patients on anticoagulation with high bleeding risks based on their ICD-9-CM or ICD-10-CM codes. Through manual chart review, we selected one unstructured note (i.e., physical exam findings, historical narratives) from each patient and identified 299 notes with and 102 free from bleeds using convenience sampling. We extracted bleeding events, labeled them as “current” or “historical”, and determined their severity (major/minor, clinically relevant/irrelevant) based on International Society on Thrombosis and Haemostasis (ISTH) criteria. Using the chart extractions as gold standard, we calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD-9-CM and ICD10-CM for detecting bleeding. Results: In Administrative claims data, ICD-9-CM had a sensitivity of 35.3%, 96.1% specificity, 96.7% PPV, and 31.2% NPV for detecting bleeding, whereas ICD-10-CM codes had a sensitivity of 55.0%, 96.3% specificity, 97. 9% PPV, and 40.6% NPV. Both ICD-CM codes exhibited better sensitivity for detecting current bleeds (41.1%, 73.4%) and major bleeds (50.0%, 62.9%) as compared with historical (32.4%, 43.8%) and minor ones (31.6%, 56.8%). Conclusions: Half of all bleeding events among patients with CVD were not reflected in administrative claims data. Although the code’s precision is acceptable, the low sensitivity suggests bleeding events may be under-reported by claims data. Our findings have important clinical implications and suggest that novel methods are needed to enhance bleeding identification to improve clinical decision making