Are the General Medical Council's Tests of Competence fair to long standing doctors? A retrospective cohort study.

The General Medical Council's Fitness to Practise investigations may involve a test of competence for doctors with performance concerns. Concern has been raised about the suitability of the test format for doctors who qualified before the introduction of Single Best Answer and Objective Structured Clinical Examination assessments, both of which form the test of competence. This study explored whether the examination formats used in the tests of competence are fair to long standing doctors who have undergone fitness to practise investigation

Thermodynamics, phase transitions and Ruppeiner geometry for Einstein-dilaton Lifshitz black holes in the presence of Maxwell and Born-Infeld electrodynamics

In this paper, we first obtain the ($n+1$)-dimensional dilaton-Lifshitz black hole (BH) solutions in the presence of Born-Infeld (BI) electrodynamics. We find that there are two different solutions for $z=n+1$ and $z\neq n+1$ cases ($z$ is dynamical critical exponent). We show that the thermodynamics first law is satisfied for both cases. Then, we turn to study different phase transitions (PTs) for our BHs. We start with study of Hawking-Page PT for both linearly and BI charged BHs. After that, we discuss the PTs inside the BHs. We present the improved Davies quantities and prove that the PT points shown by them coincide with Ruppeiner ones. We show that the zero temperature PTs are transitions on radiance properties of BHs by using Landau-Lifshitz theory. Next, we turn to study Ruppeiner geometry of linearly and BI charged BHs. For linearly charged case, we show that there are no PT at finite temperature for the case $z\geq 2$. For $z<2$, it is found that the number of finite temperature PT points depends on the value of BH charge and is not more than two. When we have two finite temperature PT points, there are no thermally stable BH between these two points and we have discontinues small/large BH PTs. As expected, for small BHs, we observe finite magnitude for Ruppeiner invariant which shows the finite correlation between possible BH molecules while for large BHs, the correlation is very small. Finally, we study the Ruppeiner geometry and thermal stability of BI charged Lifshtiz BHs for different values of $z$. We observe that small BHs are thermally unstable in some situations. Also, the behavior of correlation between possible BH molecules for large BHs is the same as linearly charged case. In both linearly and BI charged cases, for some choices of parameters, the BH systems behave like a Van der Waals gas near transition point.Comment: V2: 23 pages (revtex format), 13 figures (except one, all include subfigures), some references adde

Doctors who pilot the GMC's Tests of Competence: who volunteers and why?

Background: Doctors who are investigated by the General Medical Council (GMC) for performance concerns may be required to take a Test of Competence (ToC). The tests are piloted on volunteer doctors before they are used in Fitness to Practise (FtP) investigations. Objectives: To find out who volunteers to take a pilot ToC and why. Methods: This was a retrospective cohort study. Between February 2011 and October 2012 we asked doctors who volunteered for a test to complete a questionnaire about their reasons for volunteering and recruitment. We analysed the data using descriptive statistics and Pearson’s chi-square test. Results: 301 doctors completed the questionnaire. Doctors who took a ToC voluntarily were mostly women, of white ethnicity, of junior grades, working in general practice and who held a Primary Medical Qualification from the UK. This was a different population to doctors under investigation and all registered doctors in the UK. Most volunteers heard about the GMC’s pilot events through email from a colleague and used the experience to gain exam practice for forthcoming postgraduate exams. Conclusions: The reference group of volunteers are not representative of doctors under FtP investigation. Our findings will be used to inform future recruitment strategies with the aim to encourage better matching of groups who voluntarily pilot a ToC with those under FtP investigation

Protozoans; (Coccidia and Myxosporea;) infections in some fishes of Aras and Mahabad Dams (Northwest of Iran)

During a protozoological study on the fishes of West-Azarbayejan province (Northwest of Iran) in 1998, three different protozoans were revealed. Myxobolus musayevi from Capoeta capoeta, Myxobolus dispar from Aspius aspius taeniatus and Goussia carpelli from Cyprinus carpio. Altogether 13 different fish specimen were examined. The fishes including: Aspius aspius taeniatus (2), Rutilus ruti/us (3), Capoeta cpoeta (2) and Cyprinus carpio (6). They were caugth from Aras and Mahabad Dams and transported alive to the laboratory where they were wieghted and measured. Then, they were examined for protozoan infections when their spinal cord was cut. Myxobolus musayevi had already reported from Capoeta capoeta from Taj an in Mazandaran province. This is the first record of Myxobolus dispar from Aspius aspius taeniatus from Iranian freshwaters. Goussia carpelli also had already recorded (unpublished) from the Cyprinus carpio from Sepeedroud River in Guilan province. In this study, three of C. carpio which were caught from Aras Dam had been infected by the oocyst of the Goussia carpelli in the mocus of the intestine

Roles of estrogen receptor-alpha in mediating life span: the hypothalamic deregulation hypothesis.

In several species caloric restriction (CR) extends life span. In this paper we integrate data from studies on CR and other sources to articulate the hypothalamic deregulation hypothesis by which estrogen receptor-alpha (ER-α) signaling in the hypothalamus and limbic system affects life span under the stress of CR in mammals. ER-α is one of two principal estrogen-binding receptors differentially expressed in the amygdala, hippocampus, and several key hypothalamic nuclei: the arcuate nucleus (ARN), preoptic area (POA), ventromedial nucleus (VMN), antero ventral periventricular nucleus (AVPV), paraventricular nucleus (PVN), supraoptic nucleus (SON), and suprachiasmatic nucleus (SCN). Estradiol signaling via ER-α is essential in basal level functioning of reproductive cycle, sexually receptive behaviors, physiological stress responses, as well as sleep cycle, and other nonsexual behaviors. When an organism is placed under long-term CR, which introduces an external stress to this ER-α signaling, the reduction of ER-α expression is attenuated over time in the hypothalamus. This review paper seeks to characterize the downstream effects of ER-α in the hypothalamus and limbic system that affect normal endocrine functioning

Black Holes in (Quartic) Quasitopological Gravity

We construct quartic quasitopological gravity, a theory of gravity containing terms quartic in the curvature that yields second order differential equations in the spherically symmetric case. Up to a term proportional to the quartic term in Lovelock gravity we find a unique solution for this quartic case, valid in any dimensionality larger than 4 except 8. This case is the highest degree of curvature coupling for which explicit black hole solutions can be constructed, and we obtain and analyze the various black hole solutions that emerge from the field equations in $(n+1)$ dimensions. We discuss the thermodynamics of these black holes and compute their entropy as a function of the horizon radius. We then make some general remarks about $K$-th order quasitopological gravity, and point out that the basic structure of the solutions will be the same in any dimensionality for general $K$ apart from particular cases.Comment: LaTex, 9 figures, 27 pages. A new section on holographic hydrodynamics is added. Introduction and concluding remarks have been revise

Foodborne Listeriosis

Abstract: Foodborne listeriosis is a rare and very dangerous disease which is caused by Listeria monocytogenes. This bacterium is found in the nature in very high population, but can cause disease only in certain groups of people. Listeriosis usually happens after consumption of unpasteurized dairy products especially soft and unripe cheeses and ready to eat meat products like hot dog by susceptible people. In general, pregnant women, infants, elderly people and immuno deficient patients are susceptible to this disease. Listeria monocytogenes is able to produce septicemia, meningitis and abortion in human. The important characteristic of this bacterium is its ability to live inside the cells of immune system and by this way, it is able to distribute through body easily. In order to prevent listeriosis, susceptible people should avoid eating unpasteurized dairy products and ready to eat meats. Keywords: Foodborne disease, Listeria infections, Listeria monocytogene

How well do doctors think they perform on the General Medical Council's Tests of Competence pilot examinations? A cross-sectional study.

To investigate how accurately doctors estimated their performance on the General Medical Council's Tests of Competence pilot examinations

Realist evaluation of UK medical education quality assurance

OBJECTIVES: The aim of the study was to explore what components of the General Medical Council’s (GMC) Quality Assurance Framework work, for whom, in what circumstances and how? SETTING: UK undergraduate and postgraduate medical education and training. PARTICIPANTS: We conducted interviews with a stratified sample of 36 individuals. This included those who had direct experiences, as well as those with external insights, representing local, national and international organisations within and outside medicine. INTERVENTION: The GMC quality assure education to protect patient and public safety utilising complex intervention components including meeting standards, institutional visits and monitoring performance. However, the context in which these are implemented matters. We undertook an innovative realist evaluation to test an initial programme theory. Data were analysed using framework analysis. RESULTS: Across components of the intervention, we identified key mechanisms, including transparent reporting to promote quality improvement; dialogical feedback; partnership working facilitating interactions between regulators and providers, and role clarity in conducting proportionate interventions appropriate to risk. The GMC’s framework was commended for being comprehensive and enabling a broad understanding of an organisation’s performance. Unintended consequences included confusion over roles and boundaries in different contexts which often undermined effectiveness. CONCLUSIONS: his realist evaluation substantiates the literature and reveals deeper understandings about quality assuring medical education. While standardised approaches are implemented, interventions need to be contextually proportionate. Routine communication is beneficial to verify data, share concerns and check risk; however, ongoing partnership working can foster assurance. The study provides a modified programme theory to explicate how education providers and regulators can work more effectively together to uphold education quality, and ultimately protect public safety. The findings have influenced the GMC’s approach to quality assurance which impacts on all medical students and doctors in training