A reappraisal of the short stories of Mary Lavin

This thesis re-examines selected short stories of Irish writer Mary Lavin, placing a particular focus on fiction she published from the early 1940s to the late 1950s. Drawing on extensive archival research into Lavin's unpublished correspondence, it uncovers how the transatlantic aspects of Lavin's biography intersect with key elements of the social and cultural history of mid-twentieth-century Ireland. It also provides vital new evidence to scholars through its explicit use of correspondence between Lavin's father, Tom Lavin, and his employers, the Bird family. The thesis shows how a mixture of autobiographical experience, social and political context and an emphathetic awareness of the significance of various cultural inheritances, inflects Lavin's realist style. Analysing important stories across the main span of her writing, the thesis contends that Lavin is a major figure, with a unique perspective on her times. Despite valuable early literary studies in the late 1970s and early 1980s, and some increasing attention during the 1990s, we have only recently begun to see a more sustained resurgence of interest in Lavin's fiction. While such a shift is welcome, this thesis argues that a perceived lack of complexity in Lavin's fiction still remains and needs to be challenged in order to reveal the true value of her oeuvre. The thesis offers a new analysis of Lavin's writing that tracks major themes, appraises her use of the novella form, and recognises the richness and significance of her contribution to the Irish literary canon. In taking a fresh look at Lavin's work, it thus prepares readers for a fuller understanding of the intricacies of her art

Setting a common standard in clinical skills assessment: The experience of the California Consortium for the Assessment of Clinical Competence

Objective or purpose of innovation: To identify common clinical skills competency thresholds across schools by centralizing standard setting for a multi-institutional assessment. Background and/or theoretical framework and importance to the field: The California Consortium for the Assessment of Clinical Competence (CCACC) comprises 10 medical schools that administer a common multi-station clinical skills assessment (CPX). Previously, each institution determined their own, largely norm-referenced passing thresholds for the examination. With the elimination of USMLE Step 2 CS, there is a recognized need for robust clinical skills assessment beyond the individual institutional level. A collaboratively developed, multi-institutional examination with passing thresholds established via a rigorous process offers greater validity evidence for summative decisions made based on its results. Accordingly, the CCACC undertook centralized, criterion-based standard setting for the CPX. Design: Passing thresholds for the six core CPX cases were determined via two methods: modified Angoff, using expert raters from multiple institutions, and borderline regression, using global encounter ratings assigned by standardized patients. Results from the two methods were compared to each other and to institutions’ prior thresholds. Outcomes: Both methods yielded the same cumulative cut score based on averages across all cases (70%), but exhibited variation between individual cases, suggesting case-specificity. Compared with prior thresholds, some institutions’ pass rates would have been higher using the common criterion-referenced cut score, while others would have been lower. Innovation’s strengths and limitations: This study demonstrates the feasibility of centralizing standard setting across multiple institutions using two criterion-based methods. Standardized patient ratings may generate similar passing thresholds to those determined by clinicians. Further studies are necessary to determine whether these findings generalize to other case types and how best to apply centralized standards within each institution’s context. Feasibility and generalizability: The CCACC’s standard setting approaches may be applied across other institutions sharing an assessment, allowing for comparison of learner performance to a common standard. Given the similar results, the choice of method may be determined by resource availability

The complete genome sequence and comparative genome analysis of the high pathogenicity Yersinia enterocolitica strain 8081

The human enteropathogen, Yersinia enterocolitica, is a significant link in the range of Yersinia pathologies extending from mild gastroenteritis to bubonic plague. Comparison at the genomic level is a key step in our understanding of the genetic basis for this pathogenicity spectrum. Here we report the genome of Y. enterocolitica strain 8081 (serotype 0:8; biotype 1B) and extensive microarray data relating to the genetic diversity of the Y. enterocolitica species. Our analysis reveals that the genome of Y. enterocolitica strain 8081 is a patchwork of horizontally acquired genetic loci, including a plasticity zone of 199 kb containing an extraordinarily high density of virulence genes. Microarray analysis has provided insights into species-specific Y. enterocolitica gene functions and the intraspecies differences between the high, low, and nonpathogenic Y. enterocolitica biotypes. Through comparative genome sequence analysis we provide new information on the evolution of the Yersinia. We identify numerous loci that represent ancestral clusters of genes potentially important in enteric survival and pathogenesis, which have been lost or are in the process of being lost, in the other sequenced Yersinia lineages. Our analysis also highlights large metabolic operons in Y. enterocolitica that are absent in the related enteropathogen, Yersinia pseudotuberculosis, indicating major differences in niche and nutrients used within the mammalian gut. These include clusters directing, the production of hydrogenases, tetrathionate respiration, cobalamin synthesis, and propanediol utilisation. Along with ancestral gene clusters, the genome of Y. enterocolitica has revealed species-specific and enteropathogen-specific loci. This has provided important insights into the pathology of this bacterium and, more broadly, into the evolution of the genus. Moreover, wider investigations looking at the patterns of gene loss and gain in the Yersinia have highlighted common themes in the genome evolution of other human enteropathogens

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

The Sepsis Early Recognition and Response Initiative (SERRI)

DURATION OF INITIATIVE: 48 months and currently ongoing. SETTING: The Houston Methodist Hospital System and affiliated hospitals (3 facilities with 2 hospital-run skilled nursing facilities in and around Houston), St. Joseph’s Regional Health Center (1 acute care hospital and 2 skilled nursing facilities in Bryan, Texas), Hospital Corporation of America (2 acute care facilities in Houston, 1 acute care facility in McAllen, Texas [Rio Grande Valley]), Kindred Healthcare (2 long term acute care facilities in Houston), Select Medical Specialty Hospitals (2 long term acute care facilities in Houston). WHOM THIS SHOULD CONCERN: Hospital administrators, quality and safety officers, performance improvement and patient safety professionals, clinic managers, infection control and prevention staff, and other physicians, nurses, and clinical staff