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

Self-monitoring for improving control of blood pressue in patients with hypertension

The objective of this review is to determine the effect of SBPM in adults with hypertension on blood pressure control as compared to OBPM or usual care

A Whole-Genome RNA Interference Screen Reveals a Role for Spry2 in Insulin Transcription and the Unfolded Protein Response.

Insulin production by the pancreatic β-cell is required for normal glucose homeostasis. While key transcription factors that bind to the insulin promoter are known, relatively little is known about the upstream regulators of insulin transcription. Using a whole-genome RNA interference screen, we uncovered 26 novel regulators of insulin transcription that regulate diverse processes including oxidative phosphorylation, vesicle traffic, and the unfolded protein response (UPR). We focused on Spry2-a gene implicated in human type 2 diabetes by genome-wide association studies but without a clear connection to glucose homeostasis. We showed that Spry2 is a novel UPR target and its upregulation is dependent on PERK. Knockdown of Spry2 resulted in reduced expression of Serca2, reduced endoplasmic reticulum calcium levels, and induction of the UPR. Spry2 deletion in the adult mouse β-cell caused hyperglycemia and hypoinsulinemia. Our study greatly expands the compendium of insulin promoter regulators and demonstrates a novel β-cell link between Spry2 and human diabetes

Does risk of progression from Barrett’s esophagus to esophageal adenocarcinoma change based on the number of non-dysplastic endoscopies?

Funding: This study was funded in full by the National Institutes of Health, grant number (NIH P30DK056338‐16). The Northern Ireland Barrett’s register was funded by the UK Medical Research Council, Cancer Focus Northern Ireland (formerly the Ulster Cancer Foundation), NI HSC R&D Office, and Cancer Research UK. The Northern Ireland Cancer Registry is funded by the Public Health Agency.Peer reviewedPostprin

The Application of the Newman-Janis Algorithm in Obtaining Interior Solutions of the Kerr Metric

In this paper we present a class of metrics to be considered as new possible sources for the Kerr metric. These new solutions are generated by applying the Newman-Janis algorithm (NJA) to any static spherically symmetric (SSS) ``seed'' metric. The continuity conditions for joining any two of these new metrics is presented. A specific analysis of the joining of interior solutions to the Kerr exterior is made. The boundary conditions used are those first developed by Dormois and Israel. We find that the NJA can be used to generate new physically allowable interior solutions. These new solutions can be matched smoothly to the Kerr metric. We present a general method for finding such solutions with oblate spheroidal boundary surfaces. Finally a trial solution is found and presented.Comment: 11 pages, Latex, 4 postscript figures. To be published in Classical and Quantum Gravity. Title and abstract are now on the same pag

Young adult carers: the impact of caring on health and education

Research has shown that young people who care for parents and relatives (young carers and young adult carers) are at greater risk of mental and emotional difficulties and are more likely to do badly at school or college. To explore the difficulties faced by young adult carers (aged 14 to 25) in the UK, an online survey was conducted. Almost half (45%) of the 295 respondents reported having a mental health problem. The relationship between the extent of caring and perceived mental health problems, and the impact of caring responsibilities on work and education were investigated

Antiretroviral treatment use, co-morbidities and clinical outcomes among Aboriginal participants in the Australian HIV Observational Database (AHOD)

Background: There are few data regarding clinical care and outcomes of Indigenous Australians living with HIV and it is unknown if these differ from non-Indigenous HIV-positive Australians. Methods: AHOD commenced enrolment in 1999 and is a prospective cohort of HIV-positive participants attending HIV outpatient services throughout Australia, of which 20 (74 %) sites report Indigenous status. Data were collected up until March 2013 and compared between Indigenous and non-Indigenous participants. Person-year methods were used to compare death rates, rates of loss to follow-up and rates of laboratory testing during follow-up between Indigenous and non-Indigenous participants. Factors associated with time to first combination antiretroviral therapy (cART) regimen change were assessed using Kaplan Meier and Cox Proportional hazards methods. Results: Forty-two of 2197 (1.9 %) participants were Indigenous. Follow-up amongst Indigenous and non-Indigenous participants was 332 & 16270 person-years, respectively. HIV virological suppression was achieved in similar proportions of Indigenous and non-Indigenous participants 2 years after initiation of cART (81.0 % vs 76.5 %, p = 0.635). Indigenous status was not independently associated with shorter time to change from first- to second-line cART (aHR 0.95, 95 % CI 0.51-1.76, p = 0.957). Compared with non-Indigenous participants, Indigenous participants had significantly less frequent laboratory monitoring of CD4 count (rate:2.76 tests/year vs 2.97 tests/year, p = 0.025) and HIV viral load (rate:2.53 tests/year vs 2.93 tests/year, p < 0.001), while testing rates for lipids and blood glucose were almost half that of non-indigenous participants (rate:0.43/year vs 0.71 tests/year, p < 0.001). Loss to follow-up (23.8 % vs 29.8 %, p = 0.496) and death (2.4 % vs 7.1 %, p = 0.361) occurred in similar proportions of indigenous and non-Indigenous participants, respectively, although causes of death in both groups were mostly non-HIV-related. Conclusions: As far as we are aware, these are the first data comparing clinical outcomes between Indigenous and non-Indigenous HIV-positive Australians. The forty-two Indigenous participants represent over 10 % of all Indigenous Australians ever diagnosed with HIV. Although outcomes were not significantly different, Indigenous patients had lower rates of laboratory testing for HIV and lipid/glucose parameters. Given the elevated risk of cardiovascular disease in the general Indigenous community, the additional risk factor of HIV infection warrants further focus on modifiable risk factors to maximise life expectancy in this population

Relationship between physical attributes and heat stress in dairy cattle from different genetic groups.

Dairy cattle raised under harsh conditions have to adapt and prevent heat stress. The aim of this study was to evaluate physical characteristics and their association with heat tolerance in different genetic groups of dairy cattle. Thickness of the skin and coat, length and number of hairs, body measurements, as well as physiological parameters and body temperatures by infrared thermography were determined in 19 Holstein and 19 Girolando (½ and ¾ Holstein) cows. The Holstein cattle were less tolerant to heat stress than Girolando (GH50 and GH75 Holstein), because of the difficulty in dissipating heat due to the larger body size, as well as thicker and longer hairs. The correlations between physical characteristics, physiological parameters, and thermographic measurements prove to be inconsistent among genetic groups and therefore are not predictive of heat tolerance, while the regressions of morphometric characteristics on physiological and thermographic measures were not significant. Thus, the physical characteristics were not good predictors of physiological indices and thermographic temperature and so should not be used

Relationship between physical attributes and heat stress in dairy cattle from different genetic groups.

Dairy cattle raised under harsh conditions have to adapt and prevent heat stress. The aim of this study was to evaluate physical characteristics and their association with heat tolerance in different genetic groups of dairy cattle. Thickness of the skin and coat, length and number of hairs, body measurements, as well as physiological parameters and body temperatures by infrared thermography were determined in 19 Holstein and 19 Girolando (½ and ¾ Holstein) cows. The Holstein cattle were less tolerant to heat stress than Girolando (GH50 and GH75 Holstein), because of the difficulty in dissipating heat due to the larger body size, as well as thicker and longer hairs. The correlations between physical characteristics, physiological parameters, and thermographic measurements prove to be inconsistent among genetic groups and therefore are not predictive of heat tolerance, while the regressions of morphometric characteristics on physiological and thermographic measures were not significant. Thus, the physical characteristics were not good predictors of physiological indices and thermographic temperature and so should not be used

Multidimensional Cosmology: Spatially Homogeneous models of dimension 4+1

In this paper we classify all 4+1 cosmological models where the spatial hypersurfaces are connected and simply connected homogeneous Riemannian manifolds. These models come in two categories, multiply transitive and simply transitive models. There are in all five different multiply transitive models which cannot be considered as a special case of a simply transitive model. The classification of simply transitive models, relies heavily upon the classification of the four dimensional (real) Lie algebras. For the orthogonal case, we derive all the equations of motion and give some examples of exact solutions. Also the problem of how these models can be compactified in context with the Kaluza-Klein mechanism, is addressed.Comment: 24 pages, no figures; Refs added, typos corrected. To appear in CQ