The transition to consultant: Identifying gaps in higher specialist training

Background New consultants consistently feel better prepared for the clinical rather than non-clinical aspects of their role. However, deficiencies in generic competencies have been linked to burnout and patient complaints. This study explored how higher specialty training prepares doctors for the transition to consultant in genitourinary medicine. Results New consultants felt less prepared for non-clinical aspects of their role. Prior practical experience was the greatest influencing factor in levels of preparedness, with increased responsibility and leadership driving deeper learning. Observation of others helped individuals develop a professional identity but also learn about the wider processes within their service. The learning environment positively influenced preparedness but highlighted a need for dedicated time to learn non-clinical aspects. Conclusion To ensure future trainees feel prepared for the non-clinical aspects of the consultant role, practical experience of non-clinical areas with high levels of leadership and responsibility within a supportive learning environment is essential

Effect of Time-of-Flight and Regularized Reconstructions on Quantitative Measurements and Qualitative Assessments in Newly Diagnosed Prostate Cancer With 18F-Fluorocholine Dual Time Point PET/MRI.

Recent technical advances in positron emission tomography/magnetic resonance imaging (PET/MRI) technology allow much improved time-of-flight (TOF) and regularized iterative PET reconstruction regularized iterative reconstruction (RIR) algorithms. We evaluated the effect of TOF and RIR on standardized uptake values (maximum and peak SUV [SUVmax and SUVpeak]) and their metabolic tumor volume dependencies and visual image quality for 18F-fluorocholine PET/MRI in patients with newly diagnosed prostate cancer. Fourteen patients were administered with 3 MBq/kg of 18F-fluorocholine and scanned dynamically for 30 minutes. Positron emission tomography images were divided to early and late time points (1-6 minutes summed and 7-30 minutes summed). The values of the different SUVs were documented for dominant PET-avid lesions, and metabolic tumor volume was estimated using a 50% isocontour and SUV threshold of 2.5. Image quality was assessed via visual acuity scoring (VAS). We found that incorporation of TOF or RIR increased lesion SUVs. The lesion to background ratio was not improved by TOF reconstruction, while RIR improved the lesion to background ratio significantly ( P < .05). The values of the different VAS were all significantly higher ( P < .05) for RIR images over TOF, RIR over non-TOF, and TOF over non-TOF. In conclusion, our data indicate that TOF or RIR should be incorporated into current protocols when available

Measurement of Lumbar Multifidus Asymmetry in Amateur Cricket Pace Bowlers using Real-Time Ultrasound

International Journal of Exercise Science 11(3): 875-885, 2018. Objectives: To determine if lumbar multifidus asymmetry existed between the fifth lumbar (L5) and 1stsacral (S1) spinal level in a group of amateur cricket pace bowlers and a healthy non-cricketing group of males, and to determine if there were significant differences between groups in lumbar multifidus asymmetry at rest, on contraction, or during activation. Design: A prospective single blinded cross-sectional study. Methods: Forty healthy participants were recruited to two groups: an amateur cricket pace bowling group (n=20) and a non-cricketing group (n=20). Bilateral real-time ultrasound imaging of lumbar multifidus was conducted at the L5/S1 level in a resting and contracted state. Muscle thickness was measured and percentage activation was calculated. A force probe device was used to standardise force, inclination and roll of the ultrasound probe during real-time ultrasound imaging. Results: There was evidence of asymmetry in both groups, but differences between dominant and non-dominant sided lumbar multifidus thickness were non-significant. Between group comparisons of lumbar multifidus asymmetry indicated no significant difference for rest or activation. However, the cricket group had a significantly greater asymmetry of lumbar multifidus when contracted compared to controls (p=0.04). Conclusions: The results indicate that amateur cricket pace bowlers had significantly greater contracted lumbar multifidus asymmetry than non-cricketers. The resting lumbar multifidus asymmetries demonstrated previously in elite pace bowlers were not found in this population. Future research should investigate lumbar multifidus asymmetry in amateur pace bowlers in relation to lower back injury, and make comparisons between amateur and elite cricket pace bowlers

Signal transduction cross talk mediated by Jun N-terminal kinase-interacting protein and insulin receptor substrate scaffold protein complexes

Scaffold proteins have been established as important mediators of signal transduction specificity. The insulin receptor substrate (IRS) proteins represent a critical group of scaffold proteins that are required for signal transduction by the insulin receptor, including the activation of phosphatidylinositol 3 kinase. The c-Jun NH(2)-terminal kinase (JNK)-interacting proteins (JIPs) represent a different group of scaffold molecules that are implicated in the regulation of the JNK. These two signaling pathways are functionally linked because JNK can phosphorylate IRS1 on the negative regulatory site Ser-307. Here we demonstrate the physical association of these signaling pathways using a proteomic approach that identified insulin-regulated complexes of JIPs together with IRS scaffold proteins. Studies using mice with JIP scaffold protein defects confirm that the JIP1 and JIP2 proteins are required for normal glucose homeostasis. Together, these observations demonstrate that JIP proteins can influence insulin-stimulated signal transduction mediated by IRS proteins

Spin- and angle-resolved photoemission studies of the electronic structure of Si(110)"16x2" surfaces

The electronic structure of Si(110)"16 x 2" double-domain, single-domain and 1 x 1 surfaces have been investigated using spin- and angle-resolved photoemission at sample temperatures of 77 K and 300 K. Angle-resolved photoemission was conducted using horizontally- and vertically-polarised 60 eV and 80 eV photons. Band-dispersion maps revealed four surface states ($S_1$ to $S_4$) which were assigned to silicon dangling bonds on the basis of measured binding energies and photoemission intensity changes between horizontal and vertical light polarisations. Three surface states ($S_1$, $S_2$ and $S_4$), observed in the Si(110)"16 x 2" reconstruction, were assigned to Si adatoms and Si atoms present at the edges of the corrugated terrace structure. Only one of the four surface states, $S_3$, was observed in both the Si(110)"16 x 2" and 1 x 1 band maps and consequently attributed to the pervasive Si zigzag chains that are components of both the Si(110)"16 x 2" and 1 x 1 surfaces. A state in the bulk-band region was attributed to an in-plane bond. All data were consistent with the adatom-buckling model of the Si(110)"16 x 2" surface. Whilst room temperature measurements of $P_y$ and $P_z$ were statistically compatible with zero, $P_x$ measurements of the enantiomorphic A-type and B-type Si(110)"16 x 2" surfaces gave small average polarisations of around 1.5\% that were opposite in sign. Further measurements at 77 K on A-type Si(110)"16 x 2" surface gave a smaller value of +0.3\%. An upper limit of $\sim1\%$ may thus be taken for the longitudinal polarisation.Comment: Main paper: 12 pages and 11 figures. Supplemental information: 5 pages and 2 figure