A retrospective study of cognitive function in doctors and dentists with suspected performance problems: an unsuspected but significant concern.

OBJECTIVE: To examine the performance assessments and cognitive function of practitioners referred to the National Clinical Assessment Service (NCAS). DESIGN: Retrospective observational study. SETTING: Practitioners referred to NCAS for performance assessment due to suspected performance problems. PARTICIPANTS: One hundred and nine practitioners over the age of 45 years referred to NCAS between 1 September 2008 and 30 June 2012. MAIN OUTCOME MEASURES: Reasons for referral of practitioners and their characteristics; details of their assessments including screening for cognition using Addenbrooke's Cognitive Examination Revised (ACE-R); outcome of the process. RESULTS: Reasons for referral included 'clinical difficulties' and 'governance or safety issues'. Eighty-seven practitioners scored above 88 on ACE-R. Twenty-two were found to have an ACE-R score of ≤88. On further assessment, 14 of these 22 practitioners were found to have cognitive impairment. The majority of all practitioners were found to be performing below the expected level of practice for someone at their grade and specialty. Of those scoring ≤88 on the screening, only seven continued in clinical practice. CONCLUSIONS: A high proportion of practitioners scoring poorly on ACE-R were found to have cognitive impairment following detailed neuropsychological testing, the youngest aged 46 years. Many were working in isolation. Nearly all practitioners scoring poorly on ACE-R were international medical graduates; reasons for this are unclear. Performance assessment results showed persisting failings in the practitioners' record keeping and in their assessment of patients. Our findings highlight the need for increased vigilance and training of responsible officers to recognise performance problems and emphasise the importance of comprehensive assessment

Atmospheric extinction coefficients in the Ic\mathrm{I_c} band for several major international observatories: Results from the BiSON telescopes, 1984 to 2016

Over 30 years of solar data have been acquired by the Birmingham Solar Oscillations Network (BiSON), an international network of telescopes used to study oscillations of the Sun. Five of the six BiSON telescopes are located at major observatories. The observational sites are, in order of increasing longitude: Mount Wilson (Hale) Observatory (MWO), California, USA; Las Campanas Observatory (LCO), Chile; Observatorio del Teide, Iza\~{n}a, Tenerife, Canary Islands; the South African Astronomical Observatory (SAAO), Sutherland, South Africa; Carnarvon, Western Australia; and the Paul Wild Observatory, Narrabri, New South Wales, Australia. The BiSON data may be used to measure atmospheric extinction coefficients in the $\mathrm{I_c}$ band (approximately 700-900 nm), and presented here are the derived atmospheric extinction coefficients from each site over the years 1984 to 2016.Comment: 15 pages, 10 figures, 4 tables. Accepted by Astronomical Journal: 2017 July 2

The Galactic Exoplanet Survey Telescope (GEST)

The Galactic Exoplanet Survey Telescope (GEST) will observe a 2 square degree field in the Galactic bulge to search for extra-solar planets using a gravitational lensing technique. This gravitational lensing technique is the only method employing currently available technology that can detect Earth-mass planets at high signal-to-noise, and can measure the frequency of terrestrial planets as a function of Galactic position. GEST's sensitivity extends down to the mass of Mars, and it can detect hundreds of terrestrial planets with semi-major axes ranging from 0.7 AU to infinity. GEST will be the first truly comprehensive survey of the Galaxy for planets like those in our own Solar System.Comment: 17 pages with 13 figures, to be published in Proc. SPIE vol 4854, "Future EUV-UV and Visible Space Astrophysics Missions and Instrumentation

The use of biomedicine, complementary and alternative medicine, and ethnomedicine for the treatment of epilepsy among people of South Asian origin in the UK

Studies have shown that a significant proportion of people with epilepsy use complementary and alternative medicine (CAM). CAM use is known to vary between different ethnic groups and cultural contexts; however, little attention has been devoted to inter-ethnic differences within the UK population. We studied the use of biomedicine, complementary and alternative medicine, and ethnomedicine in a sample of people with epilepsy of South Asian origin living in the north of England. Interviews were conducted with 30 people of South Asian origin and 16 carers drawn from a sampling frame of patients over 18 years old with epilepsy, compiled from epilepsy registers and hospital databases. All interviews were tape-recorded, translated if required and transcribed. A framework approach was adopted to analyse the data. All those interviewed were taking conventional anti-epileptic drugs. Most had also sought help from traditional South Asian practitioners, but only two people had tried conventional CAM. Decisions to consult a traditional healer were taken by families rather than by individuals with epilepsy. Those who made the decision to consult a traditional healer were usually older family members and their motivations and perceptions of safety and efficacy often differed from those of the recipients of the treatment. No-one had discussed the use of traditional therapies with their doctor. The patterns observed in the UK mirrored those reported among people with epilepsy in India and Pakistan. The health care-seeking behaviour of study participants, although mainly confined within the ethnomedicine sector, shared much in common with that of people who use global CAM. The appeal of traditional therapies lay in their religious and moral legitimacy within the South Asian community, especially to the older generation who were disproportionately influential in the determination of treatment choices. As a second generation made up of people of Pakistani origin born in the UK reach the age when they are the influential decision makers in their families, resort to traditional therapies may decline. People had long experience of navigating plural systems of health care and avoided potential conflict by maintaining strict separation between different sectors. Health care practitioners need to approach these issues with sensitivity and to regard traditional healers as potential allies, rather than competitors or quacks

Absence of Meissner State and Robust Ferromagnetism in the Superconducting State of UCoGe: Possible Evidence of Spontaneous Vortex State

We report ac magnetic susceptibility and dc magnetization measurements on the superconducting ferromagnet UCoGe (with superconducting and Curie temperatures of $T_{{\rm SC}} \sim 0.5$~K and $T_{{\rm Curie}} \sim 2.5$~K, respectively). In the normal, ferromagnetic state ($T_{{\rm SC}} < T < T_{{\rm Curie}}$), the magnetization curve exhibits a hysteresis loop similar to that of a regular itinerant ferromagnet. Upon lowering the temperature below $T_{{\rm SC}}$, the spontaneous magnetization is unchanged, but the hysteresis is markedly enhanced. Even deeply inside the superconducting state, ferromagnetism is not completely shielded, and there is no Meissner region, a magnetic field region of $H < H_{\rm c1}$ (a lower critical field). From these results, we suggest that UCoGe is the first material in which ferromagnetism robustly survives in the superconducting state and a spontaneous vortex state without the Meissner state is realized.Comment: 5 pages, 4 figures, to be published in J. Phys. Soc. Jp

Quality of English inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the National Clinical Audit of Anxiety and Depression

Background Clinical audit is a sustained cyclical quality improvement process seeking to improve patient care and outcomes by evaluating services against explicit standards and implementing necessary changes. National audits aim to improve population-level clinical care by identifying unwarranted variations and making recommendations for clinicians, managers and service commissioners. The National Clinical Audit of Anxiety and Depression aimed to improve clinical care for people admitted to English hospitals for treatment of anxiety and depression, to provide comparative data on quality of care, and to support local quality improvement initiatives by identifying and sharing examples of best practice. Procedures Thirteen standards were developed based on NICE guidelines, literature review and feedback from a steering committee and reference group of service users and carers. All providers of NHS inpatient mental health services in England submitted details of between 20 and 100 service users/patients admitted between April 2017 and September 2018. To ascertain data reliability, participating services re-audited 5 sets of case-notes with a second auditor, and the coordinating team checked 10 randomly-selected sets of case-notes from 3 services, also selected at random. The reference group and steering committee identified key findings and developed a series of recommendations, which were discussed in regional quality improvement workshops and on-line webinars. Findings Data from 3795 case notes were analysed. A sizeable proportion of records indicated that at least one important aspect of initial assessment was not documented. Many service users/patients who could have benefited from an intervention targeted at optimising physical health did not receive it. Only a minority (39%) were referred for psychological therapy. Use of outcome measures varied considerably but no single outcome measure was being used routinely. Most individuals had a care plan recorded in the notes, but a review date was documented in only two-thirds, and almost half of individuals had not received a copy. Conclusions There was considerable variation between English mental health services across many variables, and much scope for improvement. Clinicians should ensure that care plans are developed collaboratively with service users/patients and identified carers should be provided with information about support services. Health services should investigate the reasons for low referral rates for psychological therapies. Clinicians should ensure all service users have jointly developed crisis plans in place at discharge. Service managers should agree outcome measures to evaluate the treatment provided and clinicians should use these measures at initial assessment and review appointments. The implementation of such changes provides an opportunity for collaborative research into mental health service delivery and quality

Life in the Atacama — Year 2: Geologic reconnaissance through long-range roving and implications on the search for life

The Life in the Atacama-2004 project, which included geological, morphological, and mineralogical mapping through combined satellite, field-based, and microscopic perspectives and long-range roving, led to the localization of potential habitats