Background: Interviews for junior doctor training posts in the UK are considered high stakes assessments following the introduction of Modernizing Medical Careers.
Aims: To examine the reliability of ...paediatric recruitment in our Deanery for specialty training (ST) in 2008.
Methods: A total of 225 candidates were interviewed for 88 posts. There were three interview stations (presentation, structured interview and communication) each lasting for 10 min. Two interviewers independently marked candidates at each station on a 5 point Likert scale. Interview scores were analysed to evaluate reliability.
Results: Reliability for ST1 interviews was excellent, reasonable for ST2 and ST3 and poor for ST4 (Cronbach's alpha of 0.908, 0.749, 0.759 and 0.648). Generalizability coefficient was good for ST1 interviews (>0.8) but for ST2-ST4 interviews was below acceptable (<0.8). Decision (D) study calculations showed up to 26 stations that were required to achieve minimum reliability.
Conclusions: This three station interview process was not reliable enough for a high stakes assessment. An increased number of stations are required to improve reliability. Further work is required to clarify the optimum number of stations to achieve minimum reliability and feasibility.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Summary
Bacterial genes for molybdenum‐containing and tungsten‐containing enzymes are often differentially regulated depending on the metal availability in the environment. Here, we describe a new ...family of transcription factors with an unusual DNA‐binding domain related to excisionases of bacteriophages. These transcription factors are associated with genes for various molybdate and tungstate‐specific transporting systems as well as molybdo/tungsto‐enzymes in a wide range of bacterial genomes. We used a combination of computational and experimental techniques to study a member of the TF family, named TaoR (for tungsten‐containing aldehyde oxidoreductase regulator). In Desulfovibrio vulgaris Hildenborough, a model bacterium for sulfate reduction studies, TaoR activates expression of aldehyde oxidoreductase aor and represses tungsten‐specific ABC‐type transporter tupABC genes under tungsten‐replete conditions. TaoR binding sites at aor promoter were identified by electrophoretic mobility shift assay and DNase I footprinting. We also reconstructed TaoR regulons in 45 Deltaproteobacteria by comparative genomics approach and predicted target genes for TaoR family members in other Proteobacteria and Firmicutes.
Findings from this 4-year longitudinal study of strategic downsizing suggest that introducing deliberate work organization and change management strategies can combat the negative effects of reduced ...head count. Results showed that there was no overall decrease in well-being from before to after downsizing for the 139 employees remaining in an organization, despite an increase in work demands. The potential detrimental effect of demands appears to have been offset by improvement in work characteristics arising from initiatives introduced as part of the downsizing strategy. This interpretation is consistent with analyses at the individual level, which showed that high demands were associated with poorer well-being but that increases in control, clarity, and participation were associated with improved well-being.
Strategies for managing respiratory motion, specifically motion-encompassing methods, in radiation therapy typically assume reproducible breathing. In reality, respiratory motion variations occur and ...ultimately cause tumor motion variations, which can result in differences between the planned and delivered dose distributions. Therefore, breathing guidance techniques have been investigated to improve respiratory reproducibility. To our knowledge, bilevel positive airway pressure (BIPAP) ventilation assistance has not been previously investigated as a technique for improving respiratory reproducibility and is the focus of this work.
Ten patients undergoing radiation therapy treatment for cancers affected by respiratory motion (eg, lung and esophagus) participated in sessions in which their breathing was recorded during their course of treatment; these sessions occurred either before or after radiation treatments. Both unassisted free-breathing (FB) and BIPAP ventilation-assisted respiratory volume data were collected from each patient using spirometry. Patients used 2 different BIPAP ventilators (fixed BIPAP and flexible BIPAP), each configured to deliver the same volume of air per breath (ie, tidal volume). The flexible BIPAP ventilator permitted patient triggering (ie, it permitted patients to initiate each breath), and the fixed BIPAP did not. Intrasession and intersession metrics quantifying tidal volume variations were calculated and compared between the specific breathing platforms (FB or BIPAP). In addition, patient tolerance of both BIPAP ventilators was qualitatively assessed through verbal feedback.
Both BIPAP ventilators were tolerated by patients, although the fixed BIPAP was not as well tolerated as the flexible BIPAP. Both BIPAP ventilators showed significant reductions (P < .05) in intrasession tidal volume variation compared with FB. However, only the fixed BIPAP significantly reduced the intersession tidal volume variation compared with FB.
Based on the established correlation between tidal volume and tumor motion, any reduction of the tidal volume variation could result in reduced tumor motion variation. Fixed BIPAP ventilation was found to be tolerated by patients and was shown to significantly reduce intrasession and intersession tidal volume variations compared with FB. Therefore, future investigation into the potential of fixed BIPAP ventilation is warranted to define the possible clinical benefits.
The history of the commons -- jointly owned land or other resources such as fisheries or forests set aside for public use -- provides a useful context for current debates over sustainability and how ...we can act as "good ancestors." In this book, Derek Wall considers the commons from antiquity to the present day, as an idea, an ecological space, an economic abstraction, and a management practice. He argues that the commons should be viewed neither as a "tragedy" of mismanagement (as the biologist Garrett Hardin wrote in 1968) nor as a panacea for solving environmental problems. Instead, Walls sees the commons as a particular form of property ownership, arguing that property rights are essential to understanding sustainability. How we use the land and its resources offers insights into how we value the environment. After defining the commons and describing the arguments of Hardin's influential article and Elinor Ostrom's more recent work on the commons, Wall offers historical case studies from the United States, England, India, and Mongolia. He examines the power of cultural norms to maintain the commons; political conflicts over the commons; and how commons have protected, or failed to protect ecosystems. Combining intellectual and material histories with an eye on contemporary debates, Wall offers an applied history that will interest academics, activists, and policy makers.
Sulfate-reducing microbes, such as Desulfovibrio vulgaris Hildenborough, cause “souring” of petroleum reservoirs through produced sulfide and precipitate heavy metals, either as sulfides or by ...alteration of the metal reduction state. Thus, inhibitors of these microbes, including nitrate and nitrite ions, are studied in order to limit their impact. Nitrite is a potent inhibitor of sulfate reducers, and it has been suggested that nitrate does not inhibit these microbes directly but by reduction to nitrite, which serves as the ultimate inhibitor. Here we provide evidence that nitrate inhibition of D. vulgaris can be independent of nitrite production. We also show that D. vulgaris can use nitrite as a nitrogen source or terminal electron acceptor for growth. Moreover, we report that use of nitrite as a terminal electron acceptor requires nitrite reductase (nrfA) as a D. vulgaris nrfA mutant cannot respire nitrite but remains capable of utilizing nitrite as a nitrogen source. These results illuminate previously uncharacterized metabolic abilities of D. vulgaris that may allow niche expansion in low-sulfate environments. Understanding these abilities may lead to better control of sulfate-reducing bacteria in industrial settings and more accurate prediction of their interactions in the environment.
Pan-BET inhibitors have shown profound efficacy in a number of in vivo preclinical models and have entered the clinic in oncology trials where adverse events have been reported. These inhibitors ...interact equipotently with the eight bromodomains of the BET family of proteins. To better understand the contribution of each domain to their efficacy and to improve from their safety profile, selective inhibitors are required. This Letter discloses the profile of GSK973, a highly selective inhibitor of the second bromodomains of the BET proteins that has undergone extensive preclinical in vitro and in vivo characterization.
The suitability of existing sources of CO2 in a region (Ireland) for use in power to gas systems was determined using multi criteria decision analysis. The main sources of CO2 were from the ...combustion of fossil fuels, cement production, alcohol production, and wastewater treatment plants. The criteria used to assess the suitability of CO2 sources were: annual quantity of CO2 emitted; concentration of CO2 in the gas; CO2 source; distance to the electricity network; and distance to the gas network. The most suitable sources of CO2 were found to be distilleries, and wastewater treatment plants with anaerobic digesters. The most suitable source of CO2, a large distillery, could be used to convert 461 GWh/a of electricity into 258 GWh/a of methane. The total electricity requirement of this system is larger than the 348 GWh of renewable electricity dispatched down in Ireland in 2015. This could allow for the conversion of electricity that would be curtailed into a valuable energy vector. The resulting methane could fuel 729 compressed natural gas fuelled buses per annum. Synergies in integrating power to gas at a wastewater treatment plant include use of oxygen in the wastewater treatment process.
•The suitability of 88 sources of CO2 for use in a power to gas system was assessed.•The most suitable sources were distilleries and wastewater treatment plants.•Distillery A could produce 258 GWh CH4 from 461 GWh of electricity to fuel 729 buses.•Distillery A could store 133% of curtailed electricity from wind turbines in 2015.•The top 12 CO2 sources could supply 72% of energy used by the two main bus fleets.
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