Preregistration house officers in general practice: review of evidence

OBJECTIVES: To examine the strengths and weaknesses of the national and local schemes for preregistration house officers to spend four months in general practice, to identify any added value from such placements, and to examine the impact on career choices. DESIGN: Review of all studies that reported on placements of preregistration house officers in general practice. SETTING: 19 accounts of preregistration house officers’ experience in general practice, ranging from single case reports to a national evaluation study, in a variety of locations in Scotland and England. PARTICIPANTS: Views of 180 preregistration house officers, 45 general practitioner trainers, and 105 consultant trainers. MAIN OUTCOME MEASURES: Main findings or themes weighted according to number of studies reporting them and weighted for sample size. RESULTS: The studies were unanimous about the educational benefits of the placements. The additional learning included communication skills, social and psychological factors in illness, patient centred consultations, broadening of knowledge base, and dealing with uncertainty about diagnosis and referral. CONCLUSIONS: Despite the reported benefits and recommendations of the scheme, it is not expanding. General practitioner trainers reported additional supervision that was unremunerated. The reforms of the senior house officer grade may resolve this problem by offering the placements to senior house officers, who require less supervision

Measurement of the parity violating 6S-7S transition amplitude in cesium achieved within 2 \times 10^{-13} atomic-unit accuracy by stimulated-emission detection

We exploit the process of asymmetry amplification by stimulated emission which provides an original method for parity violation (PV) measurements in a highly forbidden atomic transition. The method involves measurements of a chiral, transient, optical gain of a cesium vapor on the 7S-6P_{3/2} transition, probed after it is excited by an intense, linearly polarized, collinear laser, tuned to resonance for one hyperfine line of the forbidden 6S-7S transition in a longitudinal electric field. We report here a 3.5 fold increase, of the one-second-measurement sensitivity, and subsequent reduction by a factor of 3.5 of the statistical accuracy compared with our previous result [J. Gu\'ena et al., Phys. Rev. Lett. 90, 143001 (2003)]. Decisive improvements to the set-up include an increased repetition rate, better extinction of the probe beam at the end of the probe pulse and, for the first time to our knowledge, the following: a polarization-tilt magnifier, quasi-suppression of beam reflections at the cell windows, and a Cs cell with electrically conductive windows. We also present real-time tests of systematic effects, consistency checks on the data, as well as a 1% accurate measurement of the electric field seen by the atoms, from atomic signals. PV measurements performed in seven different vapor cells agree within the statistical error. Our present result is compatible with the more precise Boulder result within our present relative statistical accuracy of 2.6%, corresponding to a 2 \times 10^{-13} atomic-unit uncertainty in E_1^{pv}. Theoretical motivations for further measurements are emphasized and we give a brief overview of a recent proposal that would allow the uncertainty to be reduced to the 0.1% level by creating conditions where asymmetry amplification is much greater.Comment: Article 21 pages, 6 figures, 3 tables Typos, addition of few comments and little more data (1 week) leading to a slight reduction of the error bar Accepted for publication in Phys.Rev.

Improving the economic value of photographic screening for optical coherence tomography-detectable macular oedema : a prospective, multicentre, UK study

Peer reviewedPublisher PD

The Buckland Park air shower array

The new Buckland Park Air Shower Array has been producing analyzed shower data since July 1984. The array is described and some preliminary performance figures are presented

Large Differences in Small RNA Composition Between Human Biofluids.

Extracellular microRNAs (miRNAs) and other small RNAs are implicated in cellular communication and may be useful as disease biomarkers. We systematically compared small RNAs in 12 human biofluid types using RNA sequencing (RNA-seq). miRNAs and tRNA-derived RNAs (tDRs) accounted for the majority of mapped reads in all biofluids, but the ratio of miRNA to tDR reads varied from 72 in plasma to 0.004 in bile. miRNA levels were highly correlated across all biofluids, but levels of some miRNAs differed markedly between biofluids. tDR populations differed extensively between biofluids. Y RNA fragments were seen in all biofluids and accounted for >10% of reads in blood plasma, serum, and cerebrospinal fluid (CSF). Reads mapping exclusively to Piwi-interacting RNAs (piRNAs) were very rare, except in seminal plasma. These results demonstrate extensive differences in small RNAs between human biofluids and provide a useful resource for investigating extracellular RNA biology and developing biomarkers

Longitudinal Polarization at future e+e−e^+e^- Colliders and Virtual New Physics Effects

The theoretical merits of longitudinal polarization asymmetries of electron-positron annihilation into two final fermions at future colliders are examined, using a recently proposed theoretical description. A number of interesting features, valid for searches of virtual effects of new physics, is underlined, that is reminiscent of analogous properties valid on top of $Z$ resonance. As an application to a concrete example, we consider the case of a model with triple anomalous gauge couplings and show that the additional information provided by these asymmetries would lead to a drastic reduction of the allowed domain of the relevant parameters.Comment: 18 pages and 1 figure. e-mail: [email protected]

New Spirometry Indices for Detecting Mild Airflow Obstruction.

The diagnosis of chronic obstructive pulmonary disease (COPD) relies on demonstration of airflow obstruction. Traditional spirometric indices miss a number of subjects with respiratory symptoms or structural lung disease on imaging. We hypothesized that utilizing all data points on the expiratory spirometry curves to assess their shape will improve detection of mild airflow obstruction and structural lung disease. We analyzed spirometry data of 8307 participants enrolled in the COPDGene study, and derived metrics of airflow obstruction based on the shape on the volume-time (Parameter D), and flow-volume curves (Transition Point and Transition Distance). We tested associations of these parameters with CT measures of lung disease, respiratory morbidity, and mortality using regression analyses. There were significant correlations between FEV1/FVC with Parameter D (r = -0.83; p < 0.001), Transition Point (r = 0.69; p < 0.001), and Transition Distance (r = 0.50; p < 0.001). All metrics had significant associations with emphysema, small airway disease, dyspnea, and respiratory-quality of life (p < 0.001). The highest quartile for Parameter D was independently associated with all-cause mortality (adjusted HR 3.22,95% CI 2.42-4.27; p < 0.001) but a substantial number of participants in the highest quartile were categorized as GOLD 0 and 1 by traditional criteria (1.8% and 33.7%). Parameter D identified an additional 9.5% of participants with mild or non-recognized disease as abnormal with greater burden of structural lung disease compared with controls. The data points on the flow-volume and volume-time curves can be used to derive indices of airflow obstruction that identify additional subjects with disease who are deemed to be normal by traditional criteria

The Intrinsically X-ray Weak Quasar PHL 1811. I. X-ray Observations and Spectral Energy Distribution

This is the first of two papers reporting observations and analysis of the unusually bright (m_b=14.4), luminous (M_B=-25.5), nearby (z=0.192) narrow-line quasar PHL 1811, focusing on the X-ray properties and the spectral energy distribution. Two Chandra observations reveal a weak X-ray source with a steep spectrum. Variability by a factor of 4 between the two observations separated by 12 days suggest that the X-rays are not scattered emission. The XMM-Newton spectra are modelled in the 0.3--5 keV band by a steep power law with \Gamma = 2.3\pm 0.1, and the upper limit on intrinsic absorption is 8.7 x 10^{20} cm^{-2}. The spectral slopes are consistent with power law indices commonly observed in NLS1s, and it appears that we observe the central engine X-rays directly. Including two recent Swift ToO snapshots, a factor of ~5 variability was observed among the five X-ray observations reported here. In contrast, the UV photometry obtained by the XMM-Newton OM and Swift UVOT, and the HST spectrum reveal no significant UV variability. The \alpha_{ox} inferred from the Chandra and contemporaneous HST spectrum is -2.3 \pm 0.1, significantly steeper than observed from other quasars of the same optical luminosity. The steep, canonical X-ray spectra, lack of absorption, and significant X-ray variability lead us to conclude that PHL 1811 is intrinsically X-ray weak. We also discuss an accretion disk model, and the host galaxy of PHL 1811.Comment: 45 pages, 9 figures, accepted for publication in Ap

Is there an integrative center in the vertebrate brain-stem? A robotic evaluation of a model of the reticular formation viewed as an action selection device

Neurobehavioral data from intact, decerebrate, and neonatal rats, suggests that the reticular formation provides a brainstem substrate for action selection in the vertebrate central nervous system. In this article, Kilmer, McCulloch and Blum’s (1969, 1997) landmark reticular formation model is described and re-evaluated, both in simulation and, for the first time, as a mobile robot controller. Particular model configurations are found to provide effective action selection mechanisms in a robot survival task using either simulated or physical robots. The model’s competence is dependent on the organization of afferents from model sensory systems, and a genetic algorithm search identified a class of afferent configurations which have long survival times. The results support our proposal that the reticular formation evolved to provide effective arbitration between innate behaviors and, with the forebrain basal ganglia, may constitute the integrative, ’centrencephalic’ core of vertebrate brain architecture. Additionally, the results demonstrate that the Kilmer et al. model provides an alternative form of robot controller to those usually considered in the adaptive behavior literature

The Calibration of Mid-Infrared Star Formation Rate Indicators

With the goal of investigating the degree to which the mid-infrared emission traces the star formation rate (SFR), we analyze Spitzer 8 um and 24 um data of star-forming regions in a sample of 33 nearby galaxies with available HST/NICMOS images in the Paschen-alpha (1.8756 um) emission line. The galaxies are drawn from the Spitzer Infrared Nearby Galaxies Survey (SINGS) sample, and cover a range of morphologies and a factor ~10 in oxygen abundance. Published data on local low-metallicity starburst galaxies and Luminous Infrared Galaxies are also included in the analysis. Both the stellar-continuum-subtracted 8 um emission and the 24 um emission correlate with the extinction-corrected Pa-alpha line emission, although neither relationship is linear. Simple models of stellar populations and dust extinction and emission are able to reproduce the observed non-linear trend of the 24 um emission versus number of ionizing photons, including the modest deficiency of 24 um emission in the low metallicity regions, which results from a combination of decreasing dust opacity and dust temperature at low luminosities. Conversely, the trend of the 8 um emission as a function of the number of ionizing photons is not well reproduced by the same models. The 8 um emission is contributed, in larger measure than the 24 um emission, by dust heated by non-ionizing stellar populations, in agreement with previous findings. Two SFR calibrations, one using the 24 um emission and the other using a combination of the 24 um and H-alpha luminosities (Kennicutt et al. 2007), are presented. No calibration is presented for the 8 um emission, because of its significant dependence on both metallicity and environment. The calibrations presented here should be directly applicable to systems dominated by on-going star formation.Comment: 67 pages, 15 figures, accepted for publication on the Astrophysical Journal; replacement contains: correction to equation 8; important tweaks to equation 9; various typos correcte