The future of clinical leadership: evidence for physician leadership and the educational pathway for new leaders

Until recently, the title ‘physician leader’ was rarely heard particularly in the UK. But that is changing. Doctors are being drawn into leadership and management more systematically. New educational opportunities are being tailored to the specific needs of doctors. The change towards physician leadership is being driven by research showing that leaders who are experts in the core business, such as doctors, are associated with improved organisational performance. This article summarises that evidence and then reviews what we have learnt about how best to train future physician leaders

Structural design options for the new 34 meter beam waveguide antenna

In addition to the successful network of 34 m High Efficiency antennas recently built by JPL, the Deep Space Network (DSN) is embarking on the construction of a 34 m high performance, research and development antenna with beam waveguide optics at the Venus site. The construction of this antenna presents many engineering challenges in the area of structural, mechanical, RF, and pointing system design. A set of functional and structural design requirements is outlined to guide analysts in the final configuration selection. Five design concepts are presented covering both the conventional center-fed beam optics as well as the nonconventional, by-pass beam configuration. The merits of each concept are discussed with an emphasis on obtaining a homologous design. The preliminary results of structural optimization efforts, currently in progress, are promising, indicating the feasibility of meeting, as a minimum, all X-band (8.4 GHz) requirements, with a goal towards meeting Ka-band (32 GHz) quality performance, at the present budget constraints

Citizen advisory groups for the creation and improvement of decision aids: experience from two Swiss centers for primary care.

Guidelines for patient decision aids (DA) recommend target population involvement throughout the development process, but developers may struggle because of limited resources. We sought to develop a feasible means of getting repeated feedback from users. Between 2017 and 2020, two Swiss centers for primary care (Lausanne and Bern) created citizen advisory groups to contribute to multiple improvement cycles for colorectal, prostate and lung cancer screening DAs. Following Community Based Participatory Research principles, we collaborated with local organizations to recruit citizens aged 50 to 75 without previous cancer diagnoses. We remunerated incidental costs and participant time. One center supplemented in-person meetings by mailed paper questionnaires, while the other supplemented meetings using small-group workshops and analyses of meeting transcripts. In Lausanne, we received input from 49 participants for three DAs between 2017 and 2020. For each topic, participants gave feedback on the initial draft and 2 subsequent versions during in-person meetings with ~ 8 participants and one round of mailed questionnaires. In Bern, 10 participants were recruited among standardized patients from the university, all of whom attended in-person meetings every three months between 2017 and 2020. At both sites, numerous changes were made to the content, appearance, language, and tone of DAs and outreach materials. Participants reported high levels of satisfaction with the participative process. Citizen advisory groups are a feasible means of repeatedly incorporating end-user feedback during the creation of multiple DAs. Methodological differences between the two centers underline the need for a flexible model adapted to local needs

α1-Antitrypsin deficiency.

α1-Antitrypsin deficiency (A1ATD) is an inherited disorder caused by mutations in SERPINA1, leading to liver and lung disease. It is not a rare disorder but frequently goes underdiagnosed or misdiagnosed as asthma, chronic obstructive pulmonary disease (COPD) or cryptogenic liver disease. The most frequent disease-associated mutations include the S allele and the Z allele of SERPINA1, which lead to the accumulation of misfolded α1-antitrypsin in hepatocytes, endoplasmic reticulum stress, low circulating levels of α1-antitrypsin and liver disease. Currently, there is no cure for severe liver disease and the only management option is liver transplantation when liver failure is life-threatening. A1ATD-associated lung disease predominately occurs in adults and is caused principally by inadequate protease inhibition. Treatment of A1ATD-associated lung disease includes standard therapies that are also used for the treatment of COPD, in addition to the use of augmentation therapy (that is, infusions of human plasma-derived, purified α1-antitrypsin). New therapies that target the misfolded α1-antitrypsin or attempt to correct the underlying genetic mutation are currently under development

Relativistic Calculation of two-Electron one-Photon and Hypersatellite Transition Energies for 12≤Z≤3012\leq Z\leq30 Elements

Energies of two-electron one-photon transitions from initial double K-hole states were computed using the Dirac-Fock model. The transition energies of competing processes, the K$\alpha$ hypersatellites, were also computed. The results are compared to experiment and to other theoretical calculations.Comment: accepted versio

Resolution and enhancement in nanoantenna-based fluorescence microscopy

Single gold nanoparticles can act as nanoantennas for enhancing the fluorescence of emitters in their near-fields. Here we present experimental and theoretical studies of scanning antenna-based fluorescence microscopy as a function of the diameter of the gold nanoparticle. We examine the interplay between fluorescence enhancement and spatial resolution and discuss the requirements for deciphering single molecules in a dense sample. Resolutions better than 20 nm and fluorescence enhancement up to 30 times are demonstrated experimentally. By accounting for the tip shaft and the sample interface in finite-difference time-domain calculations, we explain why the measured fluorescence enhancements are higher in the presence of an interface than the values predicted for a homogeneous environment.Comment: 10 pages, 3 figures. accepted for publication in Nano Letter

Materials Degradation in Light Water Reactors: Life After 60,???

Nuclear reactors present a very harsh environment for components service. Components within a reactor core must tolerate high temperature water, stress, vibration, and an intense neutron field. Degradation of materials in this environment can lead to reduced performance, and in some cases, sudden failure. A recent EPRI-led study interviewed 47 US nuclear utility executives to gauge perspectives on long-term operation of nuclear reactors. Nearly 90% indicated that extensions of reactor lifetimes to beyond 60 years were likely. When polled on the most challenging issues facing further life extension, two-thirds cited plant reliability as the key issue with materials aging and cable/piping as the top concerns for plant reliability. Materials degradation within a nuclear power plant is very complex. There are many different types of materials within the reactor itself: over 25 different metal alloys can be found with can be found within the primary and secondary systems, not to mention the concrete containment vessel, instrumentation and control, and other support facilities. When this diverse set of materials is placed in the complex and harsh environment coupled with load, degradation over an extended life is indeed quite complicated. To address this issue, the USNRC has developed a Progressive Materials Degradation Approach (NUREG/CR-6923). This approach is intended to develop a foundation for appropriate actions to keep materials degradation from adversely impacting component integrity and safety and identify materials and locations where degradation can reasonably be expected in the future. Clearly, materials degradation will impact reactor reliability, availability, and potentially, safe operation. Routine surveillance and component replacement can mitigate these factors, although failures still occur. With reactor life extensions to 60 years or beyond or power uprates, many components must tolerate the reactor environment for even longer times. This may increase susceptibility for most components and may introduce new degradation modes. While all components (except perhaps the reactor vessel) can be replaced, it may not be economically favorable. Therefore, understanding, controlling, and mitigating materials degradation processes are key priorities for reactor operation, power uprate considerations, and life extensions. This document is written to give an overview of some of the materials degradation issues that may be key for extend reactor service life. A detailed description of all the possible forms of degradation is beyond the scope of this short paper and has already been described in other documents (for example, the NUREG/CR-6923). The intent of this document is to present an overview of current materials issues in the existing reactor fleet and a brief analysis of the potential impact of extending life beyond 60 years. Discussion is presented in six distinct areas: (1) Reactor pressure vessel; (2) Reactor core and primary systems; (3) Reactor secondary systems; (4) Weldments; (5) Concrete; and (6) Modeling and simulations. Following each of these areas, some research thrust directions to help identify and mitigate lifetime extension issues are proposed. Note that while piping and cabling are important for extended service, these components are discussed in more depth in a separate paper. Further, the materials degradation issues associated with fuel cladding and fuel assemblies are not discussed in this section as these components are replaced periodically and will not influence the overall lifetime of the reactor

Confocal Imaging of Biological Tissues Using Second Harmonic Generation

A confocal microscopy imaging system was devised to selectively detect Second harmonic signals generated by biological tissues. Several types of biological tissues were examined using this imaging system, including human teeth, bovine blood vessels, and chicken skin. All these tissues generated strong second harmonic signals. There is considerable evidence that the source of these signals in tissue is collagen. Collagen, the predominant component of most tissues, is known to have second order nonlinear susceptibility. This technique may have diagnostic usefulness in pathophysiological conditions characterized by changes in collagen structure including malignant transformation of nevi, progression of diabetic complications, and abnormalities in wound healing

Expressing one’s feelings and listening to others increases emotional intelligence: a pilot study of Asian medical students

<p>Background: There has been considerable interest in Emotional Intelligence (EI) in undergraduate medical education, with respect to student selection and admissions, health and well-being and academic performance. EI is a significant component of the physician-patient relationship. The emotional well-being of the physician is, therefore, a significant component in patient care. The aim is to examine the measurement of TEIQue-SF in Asian medical students and to explore how the practice of listening to the feelings of others and expressing one’s own feelings influences an individual’s EI, set in the context of the emotional well-being of a medical practitioner.</p> <p>Methods: A group of 183 international undergraduate medical students attended a half-day workshop (WS) about mental-health and well-being. They completed a self-reported measure of EI on three occasions, pre- and post-workshop, and a 1-year follow-up.</p> <p>Result: The reliability of TEIQue-SF was high and the reliabilities of its four factors were acceptable. There were strong correlations between the TEIQue-SF and personality traits. A paired t-test indicated significant positive changes after the WS for all students (n=181, p= .014), male students (n=78, p= .015) and non-Japanese students (n=112, p= .007), but a repeated measures analysis showed that one year post-workshop there were significant positive changes for all students (n=55, p= .034), female students (n=31, p= .007), especially Japanese female students (n=13, p= .023). Moreover, 80% of the students reported that they were more attentive listeners, and 60% agreed that they were more confident in dealing with emotional issues, both within themselves and in others, as a result of the workshop.</p> <p>Conclusion: This study found the measurement of TEIQue-SF is appropriate and reliable to use for Asian medical students. The mental health workshop was helpful to develop medical students’ EI but showed different results for gender and nationality. The immediate impact on the emotional awareness of individuals was particularly significant for male students and the non-Japanese group. The impact over the long term was notable for the significant increase in EI for females and Japanese. Japanese female students were more conscious about emotionality. Emotion-driven communication exercises might strongly influence the development of students’ EI over a year.</p&gt