Clinical Fellowships in Surgical Training: Analysis of a National Pan-specialty Workforce Survey

BACKGROUND: Fellowship posts are increasingly common and offer targeted opportunities for training and personal development. Despite international demand, there is little objective information quantifying this effect or the motivations behind undertaking such a post. The present study investigated surgical trainees’ fellowship aims and intentions. METHODS: An electronic, 38-item, self-administered questionnaire survey was distributed in the United Kingdom via national and regional surgical mailing lists and websites via the Association of Surgeons in Training, Royal Surgical Colleges, and Specialty Associations. RESULTS: In all, 1,581 fully completed surveys were received, and 1,365 were included in the analysis. These represented trainees in core or higher training programs or research from all specialties and training regions: 66 % were male; the mean age was 32 years; 77.6 % intended to or had already completed a fellowship. Plastic surgery (95.2 %) and cardiothoracic (88.6 %) trainees were most likely to undertake a fellowship, with pediatrics (51.2 %), and urology (54.3 %) the least likely. Fellowship uptake increased with seniority (p < 0.01) and was positively correlated (p = 0.016, r = 0.767) with increasing belief that fellowships are necessary to the attainment of clinical competence, agreed by 73.1 %. Fellowship aims were ranked in descending order of importance as attaining competence, increasing confidence, and attaining subspecialist skills. CONCLUSIONS: Over three-quarters of trainees have or will undertake a clinical fellowship, varying with gender, specialty, and seniority. Competence, confidence, and subspecialty skills development are the main aims. The findings will influence workforce planning, and perceptions that current training does not deliver sufficient levels of competence and confidence merit further investigation

Emerged Coupling of Motor Control and Morphological Development in Evolution of Multi-cellular Animats

A model for co-evolving behavior control and morphological development is presented in this paper. The development of the morphology starts with a single cell that is able to divide or die, which is controlled by a gene regulatory network. The cells are connected by springs and form the morphology of the grown individuals. The movements of animats are resulted from the shrinking and relaxation of the springs connecting the lateral cells on the body morphology. The gene regulatory network, together with the frequency and phase shifts of the spring movements are evolved to maximize the distance that the animats can swim in a given time interval. To facilitate the evolution of swimming animats, a term that awards an elongated morphology is also included in the fitness function. We show that animats with different body-plans emerge in the evolutionary runs and that the evolved movement control strategy is coupled with the body plan

From idea to product: participation of users in the development process of a multimedia platform for parental involvement in kindergarten

Parental involvement in kindergarten has been pointed out as an important factor in cognitive development, child behavior and school adaptation. In kindergarten, parents can get involved in various ways. Web technologies can facilitate two types of parental involvement: communication with the early childhood educator, to learn more about child's learning process in kindergarten, and home-based educational activities, using digital educa-tional content. In this sense, the research team set up a design research, aimed to develop a multimedia platform that promotes communication and resource sharing among educators, parents and children, to facilitate paren-tal involvement in learning. This article presents the development of the platform, from the preliminary studies to the evaluation of the functional prototype, with the participation of parents and educators in all phases of the development process.publishe

Bullying: An ecological approach to intervention in schools

Bullying is a major concern in education worldwide, particularly in countries such as New Zealand that are reported to have high rates of bullying in schools. In this article it is proposed that, in order to effectively prevent or substantially reduce bullying in schools, a systemic approach needs to be adopted, with interventions organized at various levels. An ecological model for bullying prevention is presented that suggests strategies and interventions at the levels of teachers, schools, communities, and society. Examples of interventions that have been found in the literature to have evidence supporting their effectiveness have been outlined at each of these levels. Guidelines are presented for schools adopting such an ecological model for addressing bullying and for bringing about the changes needed to implement it successfully

A nomenclature for restriction enzymes, DNA methyltransferases, homing endonucleases and their genes

A nomenclature is described for restriction endonucleases, DNA methyltransferases, homing endonucleases and related genes and gene products. It provides explicit categories for the many different Type II enzymes now identified and provides a system for naming the putative genes found by sequence analysis of microbial genomes

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Evolutionary design of soft-bodied animats with decentralized control

We show how a biologically inspired model of multicellular development combined with a simulated evolutionary process can be used to design the morphologies and controllers of soft-bodied virtual animats. An animat’s morphology is the result of a developmental process that starts from a single cell and goes through many cell divisions, during which cells interact via simple physical rules. Every cell contains the same genome, which encodes a gene regulatory network (GRN) controlling its behavior. After the developmental stage, locomotion emerges from the coordinated activity of the GRNs across the virtual robot body. Since cells act autonomously, the behavior of the animat is generated in a truly decentralized fashion. The movement of the animat is produced by the contraction and expansion of parts of the body, caused by the cells, and is simulated using a physics engine. Our system makes possible the evolution and development of animats that can run, swim, and actively navigate toward a target in a virtual environment

Bisbibenzyls, a New Type of Antifungal Agent, Inhibit Morphogenesis Switch and Biofilm Formation through Upregulation of DPP3 in Candida albicans

The yeast-to-hypha transition plays a crucial role in the pathogenesis of C. albicans. Farnesol, a quorum sensing molecule (QSM) secreted by the fungal itself, could prevent the formation of hyphae and subsequently lead to the defect of biofilm formation. The DPP3, encoding phosphatase, is a key gene in regulating farnesol synthesis. In this study, we screened 24 bisbibenzyls and 2 bibenzyls that were isolated from bryophytes or chemically synthesized by using CLSI method for antifungal effect. Seven bisbibenzyls were found to have antifungal effects with IC80 less than 32 µg/ml, and among them, plagiochin F, isoriccardin C and BS-34 were found to inhibit the hyphae and biofilm formation of C. albicans in a dose-dependent manner. To uncover the underlying relationship between morphogenesis switch and QSM formation, we measured the farnesol production by HPLC-MS and quantified Dpp3 expression by detecting the fluorescent intensity of green fluorescent protein tagged strain using Confocal Laser Scanning microscopy and Multifunction Microplate Reader. The DPP3 transcripts were determined by real-time PCR. The data indicated that the bisbibenzyls exerted antifungal effects through stimulating the synthesis of farnesol via upregulation of Dpp3, suggesting a potential antifungal application of bisbibenzyls. In addition, our assay provides a novel, visual and convenient method to measure active compounds against morphogenesis switch