Experiences of JCU MBBS graduates in remote northern Australian towns: preliminary findings

Over 65% of all James Cook University (JCU) medical graduates practise outside of major cities (compared to 20% of all Australian clinicians), including 5% who choose to practice in remote northern Australian towns such as Mount Isa, Darwin, and Palm and Thursday Islands. Many remote towns have high proportional Aboriginal and Torres Strait Islander populations. Little is known about the challenges and pressures for Australian doctors practising in remote locations; including community expectations around advocacy and leadership roles for graduates from Aboriginal or Torres Strait Islander cultures

Does the introduction of Basic Life Support (BLS) training in years 1- 4 of an undergraduate MBBS curriculum improve the knowledge, competence, and confidence of the year 4 student

Introduction: Year one medical students were assessed on their BLS skills post external Registered Training Organisation (RTO) instruction and did not meet the Australian Resuscitation Council criteria. BLS instruction was introduced into each of the first 4 years of the 6 year curriculum to address this. Aim: Evaluate the effectiveness of introducing BLS into years 1- 4 on the knowledge, competence and confidence of the year 4 student Methods: Pre:post longitudinal study comparing Control group (CG) with the Intervention Group (IG) using OSCE format as the evaluation of competence. Knowledge and confidence were measured by questionnaire. Analysis used 2-sided chi-square tests with SPPS software. Results: The IG had statistically significant improvement in responsiveness, airway, breathing and defibrillation of DRsABCD (p value <0.001) The self-reported knowledge and confidence of BLS were not significantly different between groups and did not correlate with evaluation results. Discussion: These results are supported by the literature that repetition and experiential learning is important for retention of knowledge and psychomotor skills. Self-reporting of competency did not equate to assessment findings. Conclusions: The introduction of Basic Life Support (BLS) into years 1,2,3,4 of the MBBS undergraduate curriculum along with practice sessions and assessment significantly improved the competence of BLS skills in the year 4 student

Optimized assembly design for resource efficient production in a multiproduct manufacturing system

Resource efficiency is one of the greatest challenges for sustainable manufacturing. Material flow in manufacturing systems directly influences resource efficiency, financial cost and environmental impact. A framework for material flow assessment in manufacturing systems (MFAM) was applied to a complex multi-product manufacturing case study. This supported the identification of options to alter material flow through changes to the product assembly design, to improve overall resource efficiency through eliminating resource intensive changeovers. Alternative assembly designs were examined using a combination of intelligent computation techniques: k-means clustering, genetic algorithm and ant colony algorithm. This provided recommendations balancing improvement potential with extent of process modification impact

The Growth Hormone Deficiency (GHD) Reversal Trial: effect on final height of discontinuation versus continuation of growth hormone treatment in pubertal children with isolated GHD—a non-inferiority Randomised Controlled Trial (RCT)

Background: Growth hormone deficiency (GHD) is the commonest endocrine cause of short stature and may occur in isolation (I-GHD) or combined with other pituitary hormone deficiencies. Around 500 children are diagnosed with GHD every year in the UK, of whom 75% have I-GHD. Growth hormone (GH) therapy improves growth in children with GHD, with the goal of achieving a normal final height (FH). GH therapy is given as daily injections until adult FH is reached. However, in many children with I-GHD their condition reverses, with a normal peak GH detected in 64–82% when re-tested at FH. Therefore, at some point between diagnosis and FH, I-GHD must have reversed, possibly due to increase in sex hormones during puberty. Despite increasing evidence for frequent I-GHD reversal, daily GH injections are traditionally continued until FH is achieved. // Methods/design: Evidence suggests that I-GHD children who re-test normal in early puberty reach a FH comparable to that of children without GHD. The GHD Reversal study will include 138 children from routine endocrine clinics in twelve UK and five Austrian centres with I-GHD (original peak GH < 6.7 mcg/L) whose deficiency has reversed on early re-testing. Children will be randomised to either continue or discontinue GH therapy. This phase III, international, multicentre, open-label, randomised controlled, non-inferiority trial (including an internal pilot study) will assess whether children with early I-GHD reversal who stop GH therapy achieve non-inferior near FH SDS (primary outcome; inferiority margin 0.55 SD), target height (TH) minus near FH, HRQoL, bone health index and lipid profiles (secondary outcomes) than those continuing GH. In addition, the study will assess cost-effectiveness of GH discontinuation in the early retesting scenario. // Discussion: If this study shows that a significant proportion of children with presumed I-GHD reversal generate enough GH naturally in puberty to achieve a near FH within the target range, then this new care pathway would rapidly improve national/international practice. An assumed 50% reversal rate would provide potential UK health service cost savings of £1.8–4.6 million (€2.05–5.24 million)/year in drug costs alone. This new care pathway would also prevent children from having unnecessary daily GH injections and consequent exposure to potential adverse effects. // Trial registration: EudraCT number: 2020-001006-3

Interaction-based quantum metrology showing scaling beyond the Heisenberg limit

Quantum metrology studies the use of entanglement and other quantum resources to improve precision measurement. An interferometer using N independent particles to measure a parameter X can achieve at best the "standard quantum limit" (SQL) of sensitivity {\delta}X \propto N^{-1/2}. The same interferometer using N entangled particles can achieve in principle the "Heisenberg limit" {\delta}X \propto N^{-1}, using exotic states. Recent theoretical work argues that interactions among particles may be a valuable resource for quantum metrology, allowing scaling beyond the Heisenberg limit. Specifically, a k-particle interaction will produce sensitivity {\delta}X \propto N^{-k} with appropriate entangled states and {\delta}X \propto N^{-(k-1/2)} even without entanglement. Here we demonstrate this "super-Heisenberg" scaling in a nonlinear, non-destructive measurement of the magnetisation of an atomic ensemble. We use fast optical nonlinearities to generate a pairwise photon-photon interaction (k = 2) while preserving quantum-noise-limited performance, to produce {\delta}X \propto N^{-3/2}. We observe super-Heisenberg scaling over two orders of magnitude in N, limited at large N by higher-order nonlinear effects, in good agreement with theory. For a measurement of limited duration, super-Heisenberg scaling allows the nonlinear measurement to overtake in sensitivity a comparable linear measurement with the same number of photons. In other scenarios, however, higher-order nonlinearities prevent this crossover from occurring, reflecting the subtle relationship of scaling to sensitivity in nonlinear systems. This work shows that inter-particle interactions can improve sensitivity in a quantum-limited measurement, and introduces a fundamentally new resource for quantum metrology

Quantifying signal changes in nano-wire based biosensors

In this work, we present a computational methodology for predicting the change in signal (conductance sensitivity) of a nano-BioFET sensor (a sensor based on a biomolecule binding another biomolecule attached to a nano-wire field effect transistor) upon binding its target molecule. The methodology is a combination of the screening model of surface charge sensors in liquids developed by Brandbyge and co-workers [Sørensen et al., Appl. Phys. Lett., 2007, 91, 102105], with the PROPKA method for predicting the pH-dependent charge of proteins and protein-ligand complexes, developed by Jensen and co-workers [Li et al., Proteins: Struct., Funct., Bioinf., 2005, 61, 704-721, Bas et al., Proteins: Struct., Funct., Bioinf., 2008, 73, 765-783]. The predicted change in conductance sensitivity based on this methodology is compared to previously published data on nano-BioFET sensors obtained by other groups. In addition, the conductance sensitivity dependence from various parameters is explored for a standard wire, representative of a typical experimental setup. In general, the experimental data can be reproduced with sufficient accuracy to help interpret them. The method has the potential for even more quantitative predictions when key experimental parameters (such as the charge carrier density of the nano-wire or receptor density on the device surface) can be determined (and reported) more accurately. © 2011 The Royal Society of Chemistry

Soft systems methodology: a context within a 50-year retrospective of OR/MS

Soft systems methodology (SSM) has been used in the practice of operations research and management science OR/MS) since the early 1970s. In the 1990s, it emerged as a viable academic discipline. Unfortunately, its proponents consider SSM and traditional systems thinking to be mutually exclusive. Despite the differences claimed by SSM proponents between the two, they have been complementary. An extensive sampling of the OR/MS literature over its entire lifetime demonstrates the richness with which the non-SSM literature has been addressing the very same issues as does SSM

A reafferent and feed-forward model of song syntax generation in the Bengalese finch

Adult Bengalese finches generate a variable song that obeys a distinct and individual syntax. The syntax is gradually lost over a period of days after deafening and is recovered when hearing is restored. We present a spiking neuronal network model of the song syntax generation and its loss, based on the assumption that the syntax is stored in reafferent connections from the auditory to the motor control area. Propagating synfire activity in the HVC codes for individual syllables of the song and priming signals from the auditory network reduce the competition between syllables to allow only those transitions that are permitted by the syntax. Both imprinting of song syntax within HVC and the interaction of the reafferent signal with an efference copy of the motor command are sufficient to explain the gradual loss of syntax in the absence of auditory feedback. The model also reproduces for the first time experimental findings on the influence of altered auditory feedback on the song syntax generation, and predicts song- and species-specific low frequency components in the LFP. This study illustrates how sequential compositionality following a defined syntax can be realized in networks of spiking neurons