Medical Student Perceptions of Feedback and Feedback Behaviors Within the Context of the “Educational Alliance”

Purpose: Using the "educational alliance" as a conceptual framework, the authors explored medical students' beliefs about feedback and how their feedback behaviors reflect their perceptions. Method: Five focus groups (four to six medical students each) at one UK medical school in 2015 were used to capture and elucidate learners' feedback perceptions and behaviors within the context of the learner-educator relationship. A map of key feedback opportunities across the program was used as a tool for exploring student engagement with the feedback process. Qualitative data were analyzed using an approach based on grounded theory principles. Results: Three learner feedback behaviors emerged: recognizing, using, and seeking feedback. Five core themes influencing these behaviors were generated: learner beliefs, attitudes, and perceptions; relationships; teacher attributes; mode of feedback; and learning culture. Conceptual models illustrating the relationships between the themes and each behavior were developed. Learning culture influenced all three behaviors with a wide context of influences. Conclusions: Ensuring that feedback leads to improved performance requires more than training educators in best practices. The conceptual models support the educational alliance framework and illustrate the context and complexity of learning culture surrounding the educational relationship, learner, and feedback exchange. The educational alliance approach is underpinned by a mutual understanding of purpose and responsibility. Enhancing learners' feedback literacy skills seems to be the key aspect of the educational alliance in need of attention. Empowering learners to recognize, seek, and use feedback received within diverse learning cultures is essential

Briefing Note: The legal rule that computers are presumed to be operating correctly – unforeseen and unjust consequences

The presumption that computers are reliable in England and Wales is proved to be wrong. Nicholas Bohm, James Christie, Peter Bernard Ladkin, Bev Littlewood, Paul Marshall, Stephen Mason, Martin Newby, Steven J. Murdoch, Harold Thimbleby and Martyn Thomas CB

The legal rule that computers are presumed to be operating correctly – unforeseen and unjust consequences

In England and Wales, courts consider computers, as a matter of law, to have been working correctly unless there is evidence to the contrary. Therefore, evidence produced by computers is treated as reliable unless other evidence suggests otherwise. This way of handling evidence is known as a ‘rebuttable presumption’. A court will treat a computer as if it is working perfectly unless someone can show why that is not the case. This presumption poses a challenge to those who dispute evidence produced by a computer system. Frequently the challenge is insurmountable, particularly where a substantial institution operates the system. The Post Office Horizon scandal clearly exposes the problem and the harm that may result. From 1999, the Post Office prosecuted hundreds of postmasters and Post Office employees for theft and fraud based on evidence produced by the Horizon computer system showing shortfalls in their branch accounts. In those prosecutions, the Post Office relied on the presumption that computers were operating correctly. Hundreds of postmasters and others were convicted, sentenced to terms of imprisonment, fined, or had their property confiscated. This clearly demonstrated that the Law Commission’s assertion that ‘such a regime would work fairly’ was flawed. In the December 2019 judgment in the group litigation Bates v The Post Office Ltd (No 6: Horizon Issues) Rev 1, Mr Justice Fraser concluded that it was possible that software errors in Horizon could have caused apparent shortfalls in branch accounts, rather than these being due to theft or fraud. Following this judgement, the Criminal Cases Review Commission referred an unprecedented number of convictions, based upon the supposed shortfalls in the Horizon accounts, to the Court of Appeal. Appeal courts have quashed more than 70 convictions at the time of writing. There will be many more appeals and many more convictions quashed in what is likely the largest miscarriage of justice in British history. Were it not for the group litigation, the fundamental unreliability of the software in the Post Office’s Horizon computer system would not have been revealed, as previous challenges to Horizon’s correctness were unable to rebut the presumption of reliability for computer evidence. The financial risk of bringing legal action deterred other challenges. Similar issues apply in other situations where the reliability of computer evidence is questioned, such as in payment disputes. The legal presumption, as applied in practice, has exposed widespread misunderstanding about the nature of computer failures – in particular, the fact that these are almost invariably failures of software. The presumption has been the cause of widespread injustice. There is a pressing requirement for the presumption to be re-evaluated to avoid the risk of further or continuing injustice. We propose that the presumption that computer evidence is reliable be replaced with a process where if computer evidence is challenged, a party must justify the correctness of the evidence upon which they rely. The proposed process, summarised below, requires the disclosure of documents that would already exist in any well-managed computer system. The procedural and evidential safeguards of the kind we propose would probably have avoided the disastrous repeated miscarriages of justice over the past 20 years

Briefing Note: The legal rule that computers are presumed to be operating correctly – unforeseen and unjust consequences

The presumption that computers are reliable in England and Wales is proved to be wrong

Resolving the extragalactic hard X-ray background

The origin of the hard (2-10 keV) X-ray background has remained mysterious for over 35 years. Most of the soft (0.5-2 keV) X-ray background has been resolved into discrete sources, which are primarily quasars; however, these sources do not have the flat spectral shape required to match the X-ray background spectrum. Here we report the results of an X-ray survey 30 times more sensitive than previous studies in the hard band and four times more sensitive in the soft band. The sources detected in our survey account for at least 75 per cent of the hard X-ray background. The mean X-ray spectrum of these sources is in good agreement with that of the background. The X-ray emission from the majority of the detected sources is unambiguously associated with either the nuclei of otherwise normal bright galaxies or optically faint sources, which could either be active nuclei of dust enshrouded galaxies or the first quasars at very high redshifts.Comment: Nature article in pres

XMM-Newton 13H Deep field - I. X-ray sources

We present the results of a deep X-ray survey conducted with XMM-Newton, centred on the UK ROSAT 13H deep field area. This region covers 0.18 deg^2 and is the first of two areas covered with XMM-Newton as part of an extensive multi-wavelength survey designed to study the nature and evolution of the faint X-ray source population. We have produced detailed Monte-Carlo simulations to obtain a quantitative characterisation of the source detection procedure and to assess the reliability of the resultant sourcelist. We use the simulations to establish a likelihood threshold above which we expect less than 7 (3%) of our sources to be spurious. We present the final catalogue of 225 sources. Within the central 9 arcmin, 68 per cent of source positions are accurate to 2 arcsec, making optical follow-up relatively straightforward. We construct the N(>S) relation in four energy bands: 0.2-0.5 keV, 0.5-2 keV, 2-5 keV and 5-10 keV. In all but our highest energy band we find that the source counts can be represented by a double powerlaw with a bright end slope consistent with the Euclidean case and a break around 10^-14 cgs. Below this flux the counts exhibit a flattening. Our source counts reach densities of 700, 1300, 900 and 300 deg^-2 at fluxes of 4.1x10^-16, 4.5x10^-16, 1.1x10^-15 and 5.3x10^-15 cgs in the 0.2-0.5, 0.5-2, 2-5 and 5-10 keV energy bands respectively. We have compared our source counts with those in the two Chandra deep fields and Lockman hole and find our source counts to be amongst the highest of these fields in all energy bands. We resolve >51% (>50%) of the X-ray background emission in the 1-2 keV (2-5 keV) energy bands.Comment: 27 pages, 18 figures, MNRAS accepte

Talking in the present, caring for the future: Language and environment

This paper identifies a new source that explains environmental behaviour: the presence of future tense marking in language. We predict that languages that grammatically mark the future affect speakers' intertemporal preferences and thereby reduce their willingness to address environmental problems. We first show that speakers of languages with future tense marking are less likely to adopt environmentally responsible behaviours and to support policies to prevent environmental damage. We then document that this effect holds across countries: future tense marking is an important determinant of climate change policies and global environmental cooperation. The results suggest that there may be deep and surprising obstacles for attempts to address climate change

The legal rule that computers are presumed to be operating correctly – unforeseen and unjust consequences

In England and Wales, courts consider computers, as a matter of law, to have been working correctly unless there is evidence to the contrary. Therefore, evidence produced by computers is treated as reliable unless other evidence suggests otherwise. This way of handling evidence is known as a ‘rebuttable presumption’. A court will treat a computer as if it is working perfectly unless someone can show why that is not the case. This presumption poses a challenge to those who dispute evidence produced by a computer system. Frequently the challenge is insurmountable, particularly where a substantial institution operates the system. The Post Office Horizon scandal clearly exposes the problem and the harm that may result. From 1999, the Post Office prosecuted hundreds of postmasters and Post Office employees for theft and fraud based on evidence produced by the Horizon computer system showing shortfalls in their branch accounts. In those prosecutions, the Post Office relied on the presumption that computers were operating correctly. Hundreds of postmasters and others were convicted, sentenced to terms of imprisonment, fined, or had their property confiscated. This clearly demonstrated that the Law Commission’s assertion that ‘such a regime would work fairly’ was flawed. In the December 2019 judgment in the group litigation Bates v The Post Office Ltd (No 6: Horizon Issues) Rev 1, Mr Justice Fraser concluded that it was possible that software errors in Horizon could have caused apparent shortfalls in branch accounts, rather than these being due to theft or fraud. Following this judgement, the Criminal Cases Review Commission referred an unprecedented number of convictions, based upon the supposed shortfalls in the Horizon accounts, to the Court of Appeal. Appeal courts have quashed more than 70 convictions at the time of writing. There will be many more appeals and many more convictions quashed in what is likely the largest miscarriage of justice in British history. Were it not for the group litigation, the fundamental unreliability of the software in the Post Office’s Horizon computer system would not have been revealed, as previous challenges to Horizon’s correctness were unable to rebut the presumption of reliability for computer evidence. The financial risk of bringing legal action deterred other challenges. Similar issues apply in other situations where the reliability of computer evidence is questioned, such as in payment disputes. The legal presumption, as applied in practice, has exposed widespread misunderstanding about the nature of computer failures – in particular, the fact that these are almost invariably failures of software. The presumption has been the cause of widespread injustice. There is a pressing requirement for the presumption to be re-evaluated to avoid the risk of further or continuing injustice. We propose that the presumption that computer evidence is reliable be replaced with a process where if computer evidence is challenged, a party must justify the correctness of the evidence upon which they rely. The proposed process, summarised below, requires the disclosure of documents that would already exist in any well-managed computer system. The procedural and evidential safeguards of the kind we propose would probably have avoided the disastrous repeated miscarriages of justice over the past 20 years

Abandoned Acid? Understanding Adherence to Bisphosphonate Medications for the Prevention of Osteoporosis among Older Women: A Qualitative Longitudinal Study

Background There is significant morbidity and mortality caused by the complications of osteoporosis, for which ageing is the greatest epidemiological risk factor. Preventive medications to delay osteoporosis are available, but little is known about motivators to adhere to these in the context of a symptomless condition with evidence based on screening results. Aim To describe key perceptions that influence older women's adherence and persistence with prescribed medication when identified to be at a higher than average risk of fracture. Design of Study A longitudinal qualitative study embedded within a multi-centre trial exploring the effectiveness of screening for prevention of fractures. Setting Primary care, Norfolk. United Kingdom Methods Thirty older women aged 70–85 years of age who were offered preventive medication for osteoporosis and agreed to undertake two interviews at 6 and 24 months post-first prescription. Results There were no overall predictors of adherence which varied markedly over time. Participants' perceptions and motivations to persist with medication were influenced by six core themes: understanding adherence and non-adherence, motivations and self-care, appraising and prioritising risk, anticipating and managing side effects, problems of understanding, and decision making around medication. Those engaged with supportive professionals could better tolerate and overcome barriers such as side-effects. Conclusions Many issues are raised following screening in a cohort of women who have not previously sought advice about their bone health. Adherence to preventive medication for osteoporosis is complex and multifaceted. Individual participant understanding, choice, risk and perceived need all interact to produce unpredictable patterns of usage and acceptability. There are clear implications for practice and health professionals should not assume adherence in any older women prescribed medication for the prevention of osteoporosis. The beliefs and motivations of participants and their healthcare providers regarding the need to establish acceptable medication regimes is key to promoting and sustaining adherence