Boosting clinical performance: The impact of enhanced final year placements.

BACKGROUND: This study follows on from a study that investigated how to develop effective final year medical student assistantship placements, using multidisciplinary clinical teams in planning and delivery. AIMS: This study assessed the effects on objective structured clinical examination (OSCE) performance of the in-course enhanced "super-assistantship" placement introduced to a randomly selected sample of 2013-14 final year medical students at Leeds medical school. METHODS: Quantitative data analysis was used to compare the global grades of OSCE stations between students who undertook this placement against those who did not. RESULTS: There was a small overall improvement in the "super-assistantship" student scores across the whole assessment (effect size = 0.085). "Pre-op Capacity", "Admissions Prescribing" and "Hip Pain" stations had small-medium effect sizes (0.226, 0.215, and 0.214) in favor of the intervention group. Other stations had small effect sizes (0.107-0.191), mostly in favor of the intervention group. CONCLUSIONS: The "super-assistantship" experience characterized by increasing student responsibility on placement can help to improve competence and confidence in clinical decision-making "in a simulated environment". The clinical environment and multidisciplinary team must be ready and supported to provide these opportunities effectively. Further in-course opportunities for increasing final year student responsibility should be developed

Proteomics reveals that a high-fat diet induces rapid changes in hypothalamic proteins related to neuronal damage and inflammation

Peer reviewedPublisher PD

VLBI study of maser kinematics in high-mass SFRs. I. G16.59-0.05

The present paper focuses on the high-mass star-forming region G16.59-0.05. Methods: Using the VLBA and the EVN arrays, we conducted phase-referenced observations of the three most powerful maser species in G16.59-0.05: H2O at 22.2 GHz (4 epochs), CH3OH at 6.7 GHz (3 epochs), and OH at 1.665 GHz (1 epoch). In addition, we performed high-resolution (> 0".1), high-sensitivity (< 0.1 mJy) VLA observations of the radio continuum emission from the star-forming region at 1.3 and 3.6 cm. Results: This is the first work to report accurate measurements of the "relative" proper motions of the 6.7 GHz CH3OH masers. The different spatial and 3-D velocity distribution clearly indicate that the 22 GHz water and 6.7 GHz methanol masers are tracing different kinematic environments. The bipolar distribution of 6.7 GHz maser l.o.s. velocities and the regular pattern of observed proper motions suggest that these masers are tracing rotation around a central mass of about 35 solar masses. The flattened spatial distribution of the 6.7 GHz masers, oriented NW-SE, suggests that they can originate in a disk/toroid rotating around the massive YSO which drives the 12CO(2-1) outflow, oriented NE-SW, observed on arcsec scale. The extended, radio continuum source observed close to the 6.7 GHz masers could be excited by a wide-angle wind emitted from the YSO associated with the methanol masers, and such a wind is proven to be sufficiently energetic to drive the NE-SW 12CO(2-1) outflow. The H2O masers distribute across a region offset about 0".5 to the NW of the CH3OH masers, in the same area where emission of high-density molecular tracers, typical of HMCs, was detected. We postulate that a distinct YSO, possibly in an earlier evolutionary phase than that exciting the methanol masers, is responsible for the excitation of the water masers and the HMC molecular lines. (Abridged)Comment: 20 pages, 8 figures, 3 tables, accepted by Astronomy and Astrophysic

Four nearby L dwarfs

We present spectroscopic, photometric and astrometric observations of four bright L dwarfs identified in the course of the 2MASS near-infrared survey. Our spectroscopic data extend to wavelengths shortward of 5000\AA in the L0 dwarf 2MASSJ0746+2000 and the L4 dwarf 2MASSJ0036+1840, allowing the identification of absorption bands due to MgH and CaOH. The atomic resonance lines Ca I 4227\AA and Na I 5890/5896\AA are extremely strong, with the latter having an equivalent width of 240\AA in the L4 dwarf. By spectral type L5, the D lines extend over $\sim1000$\AA and absorb a substantial fraction of the flux emitted in the V band, with a corresponding effect on the (V-I) broadband colour. The KI resonance doublet at 7665/7699\AA increases in equivalent width from spectral type M3 to M7, but decreases in strength from M7 to L0 before broadening substantially at later types. These variations are likely driven by dust formation in these cool atmospheres.Comment: to appear in AJ, January 2000; 27 pages, including 3 tables and 7 figures embedded in the tex

A uniform treatment of the orbital effects due to a violation of the Strong Equivalence Principle in the gravitational Stark-like limit

We analytically work out several effects which a violation of the Strong Equivalence Principle (SEP) induces on the orbital motion of a binary system constituted of self-gravitating bodies immersed in a constant and uniform external field. We do not restrict to the small eccentricity limit. Moreover, we do not select any specific spatial orientation of the external polarizing field. We explicitly calculate the SEP-induced mean rates of change of all the osculating Keplerian orbital elements of the binary, the perturbation of the projection of the binary orbit onto the line-of-sight, the shift of the radial velocity, and the range and range-rate signatures and as well. We find that the ratio of the SEP precessions of the node and the inclination of the binary depends only on and the pericenter of the binary itself, being independent on both the magnitude and the orientation of the polarizing field, and on the semimajor axis, the eccentricity and the node of the binary. Our results, which do not depend on any particular SEP-violating theoretical scheme, can be applied to quite general astronomical and astrophysical scenarios. They can be used to better interpret present and future SEP experiments, especially when several theoretical SEP mechanisms may be involved, and to suitably design new dedicated tests.Comment: LaTex2e, 14 pages, no figures, no tables, 42 references. To appear in Classical and Quantum Gravity (CQG

Star formation towards the Scutum tangent region and the effects of Galactic environment

By positional matching to the catalogue of Galactic Ring Survey molecular clouds, we have derived distances to 793 Bolocam Galactic Plane Survey (BGPS) sources out of a possible 806 located within the region defined by Galactic longitudes l = 28.5 degr to 31.5 degr and latitudes |b| < 1 degr. This section of the Galactic Plane contains several major features of Galactic structure at different distances, mainly mid-arm sections of the Perseus and Sagittarius spiral arms and the tangent of the Scutum-Centarus arm, which is coincident with the end of the Galactic Long Bar. By utilising the catalogued cloud distances plus new kinematic distance determinations, we are able to separate the dense BGPS clumps into these three main line-of-sight components to look for variations in star-formation properties that might be related to the different Galactic environments. We find no evidence of any difference in either the clump mass function or the average clump formation efficiency (CFE) between these components that might be attributed to environmental effects on scales comparable to Galactic-structure features. Despite having a very high star-formation rate, and containing at least one cloud with a very high CFE, the star formation associated with the Scutum-Centarus tangent does not appear to be in any way abnormal or different to that in the other two spiral-arm sections. Large variations in the CFE are found on the scale of individual clouds, however, which may be due to local triggering agents as opposed to the large-scale Galactic structure.Comment: 11 pages, 8 figures. Accepted for publication in the Monthly Notices of the Royal Astronomical Societ

Multi-frequency Study of the LMC Supernova Remnant (SNR) B0513-692 and New SNR Candidate J051327-6911

We present a new multi-wavelength study of supernova remnant (SNR) B0513-692 in the Large Magellanic Cloud (LMC). The remnant also has a strong, superposed, essentially unresolved, but unrelated radio source at its north-western edge, J051324-691049. This is identified as a likely compact HII region based on related optical imaging and spectroscopy. We use the Australia Telescope Compact Array (ATCA) at 4790 and 8640 MHz to determine the large scale morphology, spectral index and polarization characteristics of B0513-692 for the first time. We detect a strongly polarized region (49%) in the remnant's southern edge. Interestingly we also detect a small (~40 arcsec) moderately bright, but distinct optical, circular shell in our Halpha imagery which is adjacent to the compact HII region and just within the borders of the NE edge of B0513-692. We suggest this is a separate new SNR candidate based on its apparently distinct character in terms of optical morphology in 3 imaged emission lines and indicative SNR optical spectroscopy (including enhanced optical [SII] emission relative to Halpha).Comment: 12 page

Burn mortality in patients with preexisting cardiovascular disease

Introduction Burn shock, a complex process, which develops following burn leads to severe and unique derangement of cardiovascular function. Patients with preexisting comorbidities such as cardiovascular diseases may be more susceptible. We therefore sought to examine the impact of preexisting cardiovascular disease on burn outcomes. Methods A retrospective analysis of patients admitted to a regional burn center from 2002 to 2012. Independent variables analyzed included basic demographics, burn mechanism, presence of inhalation injury, TBSA, pre-existing comorbidities, and length of ICU/hospital stay. Bivariate analysis was performed and Poisson regression modeling was utilized to estimate the incidence of being in the ICU and mortality. Results There were a total of 5332 adult patients admitted over the study period. 6% (n = 428) had a preexisting cardiovascular disease. Cardiovascular disease patients had a higher mortality rate (16%) compared to those without cardiovascular disease (3%, p <0.001). The adjusted Poisson regression model to estimate incidence risk of being in intensive care unit in patients with cardiovascular disease was 33% higher compared to those without cardiovascular disease (IRR = 1.33, 95% CI = 1.22–1.47). The risk for mortality is 42% higher (IRR = 1.42, 95% CI = 1.10–1.84) for patients with pre-existing cardiovascular disease compared to those without cardiovascular disease after controlling for other covariates. Conclusion Preexisting cardiovascular disease significantly increases the risk of intensive care unit admission and mortality in burn patients. Given the increasing number of Americans with cardiovascular diseases, there will likely be a greater number of individuals at risk for worse outcomes following burn. This knowledge can help with burn prognostication

Multi-frequency study of a new Fe-rich supernova remnant in the Large Magellanic Cloud, MCSNR J0508-6902

We present a detailed radio, X-ray and optical study of a newly discovered Large Magellanic Cloud (LMC) supernova remnant (SNR) which we denote MCSNR J0508-6902. Observations from the Australian Telescope Compact Array (ATCA) and the $\textit{XMM-Newton}$ X-ray observatory are complemented by deep H$\alpha$ images and Anglo Australian Telescope AAOmega spectroscopic data to study the SNR shell and its shock-ionisation. Archival data at other wavelengths are also examined. The remnant follows a filled-in shell type morphology in the radio-continuum and has a size of $\sim$74 pc $\times$ 57 pc at the LMC distance. The X-ray emission exhibits a faint soft shell morphology with Fe-rich gas in its interior $-$ indicative of a Type Ia origin. The remnant appears to be mostly dissipated at higher radio-continuum frequencies leaving only the south-eastern limb fully detectable while in the optical it is the western side of the SNR shell that is clearly detected. The best-fit temperature to the shell X-ray emission ($kT = 0.41^{+0.05}_{-0.06}$ keV) is consistent with other large LMC SNRs. We determined an O/Fe ratio of $<21$ and an Fe mass of 0.5-1.8$~M_{\odot}$ in the interior of the remnant, both of which are consistent with the Type Ia scenario. We find an equipartition magnetic field for the remnant of $\sim$28 $\mu$G, a value typical of older SNRs and consistent with other analyses which also infer an older remnant