Understanding concepts of generalism and specialism amongst medical students at a research-intensive London Medical School

Background Many prominent UK medical organisations have identified a need for more generalist clinicians to address the complex requirements of an aging society. We sought to clarify attitudes towards “Specialists” and “Generalists” amongst medical students and junior doctors at Imperial College School of Medicine. Methods A survey exploring medical students’ beliefs was followed up by qualitative analysis of focus groups of medical students and Imperial-graduate foundation year doctors. Results First year medical students associated specialists with academia and higher income, and generalists with ease of training and job availability. Senior (Years 5/6) medical students associated specialists even more firmly with broader influence and academic work, whilst generalists were assigned lower prestige but the same workload as specialists. The medical student focus group discussed concepts of Generalism pertaining only to Primary Care. In contrast, the foundation year doctor focus group revealed that Generalism was now seen to include some hospital care, and the perception that generalists sat lower in a knowledge hierarchy had been challenged. Conclusion Perceptions that Generalism is associated with lower prestige in the medical profession are already present at the very start of medical school and seem to be reinforced during undergraduate training. In early postgraduate clinical practice, the perceived knowledge and prestige hierarchy lessens. These findings can help inform curriculum redesign and the promotion of Generalism as a rewarding career aspiration

Experimental Determination of Load Carrying Capacity of Point Contacts at Zero Entrainment Velocity

A capacitance technique was used to monitor the film thickness separating two steel balls of a unique tribometer while subjecting the ball-ball contact to highly stressed, zero entrainment velocity (ZEV) conditions. All tests were performed under a N2 purge (R.H. < 1.0%) and utilized 52100 steel balls (R(sub a) = 0.02 mm). Tribometer operations and capacitance-to-film-thickness accuracy were verified by comparing the film thickness approximations to established theoretical predictions for test conditions involving pure rolling. Pure rolling experiments were performed under maximum contact stresses and entrainment velocities of 1.0 GPa and 1.0 m/s to 3.0 m/s, respectively. All data from these baseline tests conformed to theory. ZEV tests were initiated after calibration of the tribometer and verification of film thickness approximation accuracy. Maximum contact stresses up to 0.57 GPa were supported at zero entrainment velocity with sliding speeds from 6.0 to 10.0 m/s for sustained amounts of time up to 28.8 minutes. The protective lubricating film separating the specimens at ZEV had a thickness between 0.10 and 0.14 mm (4 to 6 min), which corresponds to an approximate L-value of 4. The film thickness did not have a strong dependence upon variations of load or speed. Decreasing the sliding speed from 10.0 m/s to 1 m/s revealed a rapid loss in load support between 3.0 and 1.0 m/s. The formation of an immobile film formed by lubricant entrapment is discussed as an explanation of the load carrying capacity at these zero entrainment velocity conditions, relevant to the ball-ball contact application in retainerless ball bearings

Experimental Study of Load Carrying Capacity of Point Contacts at Zero Entrainment Velocity

A capacitance technique was used to monitor the film thickness separating two steel balls while subjecting the ball-ball contact to highly stressed, zero entrainment velocity conditions. Tests were performed in a nitrogen atmosphere and utilized 52100 steel balls and a polyalphaolefin lubricant. Capacitance to film thickness accuracy was verified under pure rolling conditions using established EHL theory. Zero entrainment velocity tests were performed at sliding speeds from 6.0 to 10.0 m/s and for sustained amounts of time to 28.8 min. The protective lubricant film separating the specimens at zero entrainment velocity had a film thickness between 0.10 to 0.14 microns (4 to 6 micro in.), which corresponded to a k value of 4. The formation of an immobile surface film formed by lubricant entrapment is discussed as an explanation of the load carrying capacity at zero entrainment velocity conditions, relevant to the ball-ball contacts occurring in retainerless ball bearings

The use of a synthetic shoulder patch for large and massive rotator cuff tears – a feasibility study

Background The aim of this study was to explore the feasibility of using a non-absorbable biocompatible polyester patch to augment open repair of massive rotator cuff tears (Patch group) and compare outcomes with other treatment options (Non-patch group). Methods Participants referred to orthopaedic clinics for rotator cuff surgery were recruited. Choice of intervention (Patch or Non-patch) was based on patient preference and intra-operative findings. Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), and Constant score were completed at baseline and 6 months. Shoulder MRI was performed at baseline and 6 months to assess fat fraction and Goutallier classification pre- and post- treatment. Feasibility outcomes (including retention, consent and missing data) were assessed. Results Sixty-eight participants (29 in the Patch group, 39 in Non-patch group) were included (mean age 65.3 years). Conversion to consent (92.6%), missing data (0% at baseline), and attrition rate (16%) were deemed successful feasibility endpoints. There was significant improvement in the Patch group compared to Non-patch at 6 months in OSS (difference in medians 9.76 (95% CI 2.25, 17.29) and SPADI: 22.97 (95% CI 3.02, 42.92), with no substantive differences in Constant score. The patch group had a higher proportion of participants improving greater than MCID for OSS (78% vs 62%) and SPADI (63% vs 50%) respectively. Analysis of the 48 paired MRIs demonstrated a slight increase in the fat fraction for supraspinatus (53 to 55%), and infraspinatus (26 to 29%) at 6 months. These differences were similar and in the same direction when the participants were analysed by treatment group. The Goutallier score remained the same or worsened one grade in both groups equally. Conclusions This study indicates that a definitive clinical trial investigating the use of a non-absorbable patch to augment repair of massive rotator cuff tears is feasible. In such patients, the patch has the potential to improve shoulder symptoms at 6 months

Towards UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): protocol for an evaluation of the requirements for arthroplasty follow-up, and the production of consensus-based recommendations

Introduction: Hip and knee arthroplasties have revolutionised the management of degenerative joint diseases and, due to an ageing population, are becoming increasingly common. Follow-up of joint prostheses is to identify problems in symptomatic or asymptomatic patients due to infection, osteolysis, bone loss or potential peri-prosthetic fracture, enabling timely intervention to prevent catastrophic failure at a later date. Early revision is usually more straight-forward surgically and less traumatic for the patient. However, routine long-term follow-up is costly and requires considerable clinical time. Therefore, some centres in the UK have curtailed this aspect of primary hip and knee arthroplasty services, doing so without an evidence-base that such disinvestment is clinically- or cost-effective. Methods: Given the timeline from joint replacement to revision, conducting a randomised controlled trial (RCT) to determine potential consequences of disinvestment in hip and knee arthroplasty follow-up is not feasible. Furthermore the low revision rates of modern prostheses, less than 10% at 10 years, would necessitate thousands of patients to adequately power such a study. The huge variation in follow-up practice across the UK also limits the generalisability of an RCT. This study will therefore use a mixed-methods approach to examine the requirements for arthroplasty follow-up and produce evidence- and consensus-based recommendations as to how, when and on whom follow-up should be conducted. Four interconnected work packages will be completed: 1) a systematic literature review; 2a) analysis of routinely-collected NHS data from five national datasets to understand when and which patients present for revision surgery; 2b) prospective data regarding how patients currently present for revision surgery; 3) economic modelling to simulate long-term costs and quality-adjusted life years associated with different follow-up care models; 4) a Delphi-consensus process, involving all stakeholders, to develop a policy document which includes a stratification algorithm to determine appropriate follow-up care for an individual patient

Microstructured catalytic hollow fiber reactor for methane steam reforming

Microstructured alumina hollow fibers, which contain a plurality of radial microchannels with significant openings on the inner surface, have been fabricated in this study and used to develop an efficient catalytic hollow fiber reactor. Apart from low mass-transfer resistance, a unique structure of this type facilitates the incorporation of Ni-based catalysts, which can be with or without the aged secondary support, SBA-15. In contrast to a fixed bed reactor, the catalytic hollow fiber reactor shows similar methane conversion, with a gas hourly space velocity that is approximately 6.5 times higher, a significantly greater CO2 selectivity, and better productivity rates. These results demonstrate the advantages of dispersing the catalyst inside the microstructured hollow fiber as well as the potential to reduce the required quantity of catalyst

The rocky shore biology of Bantry Bay: a re-survey

A survey of the distribution and abundance of intertidal rocky shore animals and plants of Bantry Bay was carried out in 1970 and 1971 by G. B. Crapp and published in 1973. A re-survey was carried out during 1975 and early 1976 and a number of changes were noted. In an attempt to explain these the possible effects of changing weather conditions, the occurrence of oil spillages and the use of dispersants were examined. In most cases, the changes were not obviously attributable to visible oil pollution and seem more likely to result from a variety of natural factors. The re-survey highlighted a number of problems associated with this type of biological monitoring. The problems are discussed and some alternative approaches suggested

Three-Dimensional Object Registration Using Wavelet Features

Recent developments in shape-based modeling and data acquisition have brought three-dimensional models to the forefront of computer graphics and visualization research. New data acquisition methods are producing large numbers of models in a variety of fields. Three-dimensional registration (alignment) is key to the useful application of such models in areas from automated surface inspection to cancer detection and surgery. The algorithms developed in this research accomplish automatic registration of three-dimensional voxelized models. We employ features in a wavelet transform domain to accomplish registration. The features are extracted in a multi-resolutional format, thus delineating features at various scales for robust and rapid matching. Registration is achieved by using a voting scheme to select peaks in sets of rotation quaternions, then separately identifying translation. The method is robust to occlusion, clutter, and noise. The efficacy of the algorithm is demonstrated through examples from solid modeling and medical imaging applications

Multilingual representations for low resource speech recognition and keyword search

© 2015 IEEE. This paper examines the impact of multilingual (ML) acoustic representations on Automatic Speech Recognition (ASR) and keyword search (KWS) for low resource languages in the context of the OpenKWS15 evaluation of the IARPA Babel program. The task is to develop Swahili ASR and KWS systems within two weeks using as little as 3 hours of transcribed data. Multilingual acoustic representations proved to be crucial for building these systems under strict time constraints. The paper discusses several key insights on how these representations are derived and used. First, we present a data sampling strategy that can speed up the training of multilingual representations without appreciable loss in ASR performance. Second, we show that fusion of diverse multilingual representations developed at different LORELEI sites yields substantial ASR and KWS gains. Speaker adaptation and data augmentation of these representations improves both ASR and KWS performance (up to 8.7% relative). Third, incorporating un-transcribed data through semi-supervised learning, improves WER and KWS performance. Finally, we show that these multilingual representations significantly improve ASR and KWS performance (relative 9% for WER and 5% for MTWV) even when forty hours of transcribed audio in the target language is available. Multilingual representations significantly contributed to the LORELEI KWS systems winning the OpenKWS15 evaluation