The academic backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors

Background: Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude). Sex and ethnic differences were also analyzed in light of the changing demographics of medical students over the past decades. Methods: Data from five cohort studies were available: the Westminster Study (began clinical studies from 1975 to 1982), the 1980, 1985, and 1990 cohort studies (entered medical school in 1981, 1986, and 1991), and the University College London Medical School (UCLMS) Cohort Study (entered clinical studies in 2005 and 2006). Different studies had different outcome measures, but most had performance on basic medical sciences and clinical examinations at medical school, performance in Membership of the Royal Colleges of Physicians (MRCP(UK)) examinations, and being on the General Medical Council Specialist Register. Results: Correlation matrices and path analyses are presented. There were robust correlations across different years at medical school, and medical school performance also predicted MRCP(UK) performance and being on the GMC Specialist Register. A-levels correlated somewhat less with undergraduate and post-graduate performance, but there was restriction of range in entrants. General Certificate of Secondary Education (GCSE)/O-level results also predicted undergraduate and post-graduate outcomes, but less so than did A-level results, but there may be incremental validity for clinical and post-graduate performance. The AH5 had some significant correlations with outcome, but they were inconsistent. Sex and ethnicity also had predictive effects on measures of educational attainment, undergraduate, and post-graduate performance. Women performed better in assessments but were less likely to be on the Specialist Register. Non-white participants generally underperformed in undergraduate and post-graduate assessments, but were equally likely to be on the Specialist Register. There was a suggestion of smaller ethnicity effects in earlier studies. Conclusions: The existence of the Academic Backbone concept is strongly supported, with attainment at secondary school predicting performance in undergraduate and post-graduate medical assessments, and the effects spanning many years. The Academic Backbone is conceptualized in terms of the development of more sophisticated underlying structures of knowledge ('cognitive capital’ and 'medical capital’). The Academic Backbone provides strong support for using measures of educational attainment, particularly A-levels, in student selection

Revisiting the one in four: the prevalence of psychiatric disorder in the population of England 2000-2014

Mental health problems are often said to affect one in four people in Britain, although with no consistent explanation of what the figure includes. We used three English national population surveys of psychiatric morbidity from 2000, 2007 and 2014 to provide prevalence rates for recent psychiatric problems. We combined disorders progressively to demonstrate the effects of cumulation. Psychosis had a prevalence of around 1%, severe common mental disorders added about 8%, and including less-severe common mental disorders gave a value around one in six. The figure of one in four required the inclusion of various other disorders. These values were strikingly stable over the surveys

Common mental illness in people with sensory impairment: results from the 2014 adult psychiatric morbidity survey

BACKGROUND: People with sensory impairments may be at increased risk of depression and anxiety but experience barriers to accessing treatment. AIMS: To investigate whether people with sensory impairment have more depressive and anxiety symptoms than people without, whether this is mediated by social functioning and whether they report greater non-treatment. METHOD: We analysed data from the English 2014 Adult Psychiatric Morbidity Survey using regression models, with the Clinical Interview Schedule-Revised (CIS-R) score as the primary outcome and self-reported hearing and vision impairment as exposures. A secondary outcome was self-reported receipt of mental health diagnosis and treatment. We used structural equation modelling to assess for mediation by social functioning. RESULTS: A total of 19.0% of people with hearing impairment, and 30.9% and 24.5% with distance and near visual impairments, respectively, had clinically significant psychological morbidity. Adjusted mean CIS-R score was 1.86 points higher in people with hearing impairment compared with those without (95% CI 1.30-2.42, P<0.001). People with distance and near vision impairment had mean CIS-R scores 3.61 (95% CI 2.58-4.63, P<0.001) and 2.74 (95% CI 2.12-3.37, P<0.001) points higher, respectively, than those without. Social functioning accounted for approximately 50% of these relationships between sensory impairment and psychological morbidity. We found no evidence of an increased treatment gap for people with sensory impairment. CONCLUSIONS: Social functioning, a potentially modifiable target, may mediate an association between sensory impairment and depressive and anxiety symptoms

Construct-level predictive validity of educational attainment and intellectual aptitude tests in medical student selection: meta-regression of six UK longitudinal studies

Background: Measures used for medical student selection should predict future performance during training. A problem for any selection study is that predictor-outcome correlations are known only in those who have been selected, whereas selectors need to know how measures would predict in the entire pool of applicants. That problem of interpretation can be solved by calculating construct-level predictive validity, an estimate of true predictor-outcome correlation across the range of applicant abilities. Methods: Construct-level predictive validities were calculated in six cohort studies of medical student selection and training (student entry, 1972 to 2009) for a range of predictors, including A-levels, General Certificates of Secondary Education (GCSEs)/O-levels, and aptitude tests (AH5 and UK Clinical Aptitude Test (UKCAT)). Outcomes included undergraduate basic medical science and finals assessments, as well as postgraduate measures of Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) performance and entry in the Specialist Register. Construct-level predictive validity was calculated with the method of Hunter, Schmidt and Le (2006), adapted to correct for right-censorship of examination results due to grade inflation. Results: Meta-regression analyzed 57 separate predictor-outcome correlations (POCs) and construct-level predictive validities (CLPVs). Mean CLPVs are substantially higher (.450) than mean POCs (.171). Mean CLPVs for first-year examinations, were high for A-levels (.809; CI: .501 to .935), and lower for GCSEs/O-levels (.332; CI: .024 to .583) and UKCAT (mean = .245; CI: .207 to .276). A-levels had higher CLPVs for all undergraduate and postgraduate assessments than did GCSEs/O-levels and intellectual aptitude tests. CLPVs of educational attainment measures decline somewhat during training, but continue to predict postgraduate performance. Intellectual aptitude tests have lower CLPVs than A-levels or GCSEs/O-levels. Conclusions: Educational attainment has strong CLPVs for undergraduate and postgraduate performance, accounting for perhaps 65% of true variance in first year performance. Such CLPVs justify the use of educational attainment measure in selection, but also raise a key theoretical question concerning the remaining 35% of variance (and measurement error, range restriction and right-censorship have been taken into account). Just as in astrophysics, ‘dark matter’ and ‘dark energy’ are posited to balance various theoretical equations, so medical student selection must also have its ‘dark variance’, whose nature is not yet properly characterized, but explains a third of the variation in performance during training. Some variance probably relates to factors which are unpredictable at selection, such as illness or other life events, but some is probably also associated with factors such as personality, motivation or study skills

The impact of fish oil fatty-acids on post-prandial vascular reactivity.

Progressive loss of vascular reactivity and increased vascular tone with age are being increasingly recognised as significant cardiovascular disease (CVD) risk factors. The vasculature has emerged as a target for dietary strategies to modify these progressions. Our previous data suggest that inclusion of fish oil in a high-fat test meal improves postprandial vascular reactivity in healthy men. The primary aim of this project was to determine the individual effects of the fish oil fatty acids, eicosapentaenoic acid (EPA) versus docosahexaenoic acid (DHA) on post-prandial vascular reactivity and to identify underlying molecular mechanisms of these effects. In this study, the acute effects of a single dose (4.16g) of EPA, DHA and placebo oil on postprandial vascular reactivity were determined in men categorised as being at a 1.5 relative risk of CVD in a double-blind randomised crossover trial. Measures of vascular tone and function, alongside an endothelium dependent measure of vascular reactivity, were taken along with blood samples, at baseline and at 4 hours in order to coincide with the anticipated peak plasma concentration of these fatty acids. These blood samples were utilised for assessment of biomarkers associated with changes in vascular tone and postprandial whole blood culture (WBC). WBC was conducted to investigate the effect of changes in the postprandial lipidome, dependent on EPA and DHA consumption, on cytokine production. Response to intervention according to genotype was also determined retrospectively. We observed that DHA (p=0.04) but not EPA (p=0.06) significantly reduced Augmentation Index (AI) postprandially when compared to control. AI was reduced by 13.3% and 11.3% in response to DHA and EPA respectively. In addition, our data shows for the first time, that levels of the vasoactive n-3 PUFA epoxide and diol metabolites are subject to large changes post consumption of physiological levels of EPA and DHA. Our data also suggests there is wide inter-individual variability in circulating levels of these compounds, which may in part explain inter-individual responsiveness to EPA and DHA. We were not able to observe changes in plasma nitrite or H2S levels postprandially, suggesting that EPA and DHA dependent changes in vascular tone may be mediated in part by their vasoactive epoxide and diol metabolites. However, whole Blood Culture experiments did not show a significant effect on any of the cytokines or growth factors investigated, before or after correction for BMI and AGE. Finally, our investigations of response to treatment by genotype suggested a novel interaction between the PPAR-ƴ rs1801282 polymorphism, DHA consumption and improvements in postprandial triglyceridemia. The findings of this thesis emphasise the differential effects of EPA and DHA in the vasculature and the inter-individual responsiveness to these nutrients

A monochrome view of colour

Saunders & van Brakel's criticism of Berlin & Kay's methodology misunderstands the fact that scientific hypotheses are tested by generating new, replicable data with novel explanatory power. Thus, although Berlin and Kay studied differences in colour words between language, the same patterns are also present in colour word usage within languages, in a range of literary and other textual databases

The World\u27s Worst Dictionary

From any standard dictionary, we minimally expect the complete inclusion of basic words, consistency in choice of further entries, and evidence of general care in proofreading. To appreciate these qualities\u27 importance, consider a small dictionary notable for their prodigious absence. I refer to Webster\u27s Dictionary of the English Language: Handy School and Office Edition (HSOE). My copy is a red paperback volume, a revised edition published in 1979 by Book-Craft Guild, Inc., New York. A nearly-identical hardback edition bears a 1976 publishing date

Colour word usage within languages follows the Berlin and Kay ordering

Colour word usage within languages follows the same ordering as that proposed by Berlin and Kay between languages. This provides additional validation and support for Berlin and Kay's schema

Unity in the wild variety of nature, or just variety?

Although there are some common underlying mechanisms for many nonhuman behavioural asymmetries, the evidence at present is not compelling for commonalities in cerebral organisation across vertebrates. Phylogenetic analysis of detour behaviour in fish suggests that more closely related species are not particularly similar in the direction of turning; contingency and demands of ecological niches may better explain such asymmetries

A Word-Watcher\u27s Abecedary

We folk etymologists have a cardinal rule: never look up unfamiliar words in the dictionary! One can invariably guess their meaning by context and syllabic division alone. Besides, only by this method could anyone intuit the nature of eponymous creatures such as the following