Search

This is the first multisite investigation of the validity of scores from the current version of the Medical College Admission Test (MCAT) in clerkship and licensure contexts. It examined the predictive validity of MCAT scores and undergraduate grade point averages (UGPAs) for performance in preclerkship and clerkship courses and on the United States Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge examinations. It also studied students' progress in medical school.Researchers examined data from 17 U.S. and Canadian MD-granting medical schools for 2016 and 2017 entrants who volunteered for the research and applied with scores from the current MCAT exam. They also examined data for all U.S. medical schools for 2016 and 2017 entrants to regular-MD programs who applied with scores from the current exam. Researchers conducted linear and logistic regression analyses to determine whether MCAT total scores added value beyond UGPAs in predicting medical students' performance and progress. Importantly, they examined the comparability of prediction by sex, race and ethnicity, and socioeconomic status.Researchers reported medium to large correlations between MCAT total scores and medical student outcomes. Correlations between total UGPAs and medical student outcomes were similar but slightly lower. When MCAT scores and UGPAs were used together, they predicted student performance and progress better than either alone. Despite differences in average MCAT scores and UGPAs between students who self-identified as White or Asian and those from underrepresented racial and ethnic groups, predictive validity results were comparable. The same was true for students from different socioeconomic backgrounds, and for males and females.These data demonstrate that MCAT scores add value to the prediction of medical student performance and progress and that applicants from different backgrounds who enter medical school with similar ranges of MCAT scores and UGPAs perform similarly in the curriculum.

Putnam’s seminal work on social capital focused on early forms of health insurance as both a result, and accelerator, of the norms of reciprocity and social trust that foster cooperation. Yet, while social capital has been studied as a factor supporting community-based health insurance in developing countries, there has been no analysis of its role in U.S. health insurance. With repeal of the mandate to carry health insurance, this product is once again a purely voluntary purchase, and bears analysis as a cooperation problem. Putnam later documented a sharp decline in social capital in the United States. If social capital undergirds participation in health insurance, we can expect reduced reciprocity to lower willingness to cross-subsidize the sick. Waning social capital could also manifest itself in reduced trust that other healthy people will purchase insurance and lack of trust in the providers and manufacturers who make claims on the insurance pool.

L-theanine (L-THE) is a green tea-derived amino acid, consumed for its many benefits, including improved cardiovascular health, anxiolytic effects, antioxidant properties, and its effect on instigating a state of relaxed alertness. The aim of this clinical trial is to evaluate the effectiveness of the amino acid L-THE embedded in functional food whey protein mango sorbet, its related stress effects on physiological responses, state of alertness, and focus, and the accuracy of eye movements post-consumption.

The sale of financial services products is rife with information asymmetry favoring sellers and leads to the marketing of insurance products offering low value to consumers. Exemplifying this problem is the current market for ancillary health insurance products such as short-term health insurance and supplemental insurance. One policy option for state insurance regulators is to mandate a robust regime of disclosures and labeling, described here as comparative disclosures. This article reviews comparative disclosure regulations previously implemented in the U.S. and proposals for reforms. It then outlines a possible policy solution for the lack of value in ancillary health insurance products: expanding consumer information to facilitate shopping.

High intensity, high-repetition rate (HRR) lasers, that is lasers that can operate on the order of 1 Hz or faster, are quickly coming on-line around the world. High intensity lasers have long been an impactful tool in high energy density (HED) science since they are capable of creating matter at extreme temperatures and pressures relevant to this field. The advent of HRR technology enhances to this capability since HRR enables these types of these experiments to be performed faster, thus leading to an acceleration in the rate of learning in fundamental HED science. However, in order to use the full potential of HRR systems, high repetition rate diagnostics in addition to real-time analysis tools must be developed to process experimental measurements and outputs at a rate that matches the laser. Towards this goal, we present an automated machine learning based analysis for a synthetic X-ray spectrometer, which is a common diagnostic in HED experiments.

l-Theanine (l-THE) is a nonproteinogenic amino acid derived from green tea (Camellia sinensis), which exhibits strong antioxidant-like properties and contributes to the favourable umami taste sensation. Several studies have reported that the consumption of this amino acid has many therapeutic effects, including improvements in brain and gastrointestinal function, cancer drug therapeutic efficacies, antihypertensive effects, and improved immune function. Considering the recent Western commercialisation and popularity of green tea consumption as a nootropic agent in humans, the aims of this review were to consolidate the existing knowledge from ex vivo and in vitro animal models and attempt to highlight the applicability of l-THE towards the human clinical trials. Considering the anti-inflammatory and antioxidants effects of l-THE presented in the current review, further research must translate the existing knowledge gained from animal and cell models to exploring the potential metabolic health benefits and moderating effects on the pathogenesis of conditions such as obesity, arthritis, depression, and type 2 diabetes in human trials. This will bridge the gap in literature and provide more insights into the mechanisms driving pathologies characterised by the inflammatory response and oxidative stress.

Consumption of L-Theanine (L-THE) has been associated with a sensation of relaxation, as well as a reduction of stress. However, these physiological responses have yet to be elucidated in humans where L-THE is compared alongside food or as a functional ingredient within the food matrix. The aim of this study was to determine the physiological responses of a single intake of a potential functional food product (mango sorbet) containing L-THE (ms-L-THE, 200 mgw/w) in comparison to a flavour and colour-matched placebo (ms). Eighteen healthy male participants were recruited in this randomised, double-blind, placebo-controlled trial. The participants were required to consume ms-L-THE or placebo and their blood pressure (BP) (systolic and diastolic), heart rate (HR), and heart rate variability (HRV) were monitored continuously over 90 minutes. Eleven males (age 27.7 ± 10.8 years) completed the study. Changes in area under the curve for systolic and diastolic blood pressure and HRV over the 90 minute observation period indicated no differences between the three conditions (all p &gt, 0.05) or within individual groups (all p &gt, 0.05). The values for heart rate were also not different in the placebo group (p = 0.996) and treatment group (p = 0.066), while there was a difference seen at the baseline (p = 0.003). Based on the findings of this study, L-THE incorporated in a food matrix (mango sorbet) demonstrated no reduction in BP or HR and showed no significant parasympathetic interaction as determined by HRV high-frequency band and low-frequency/high-frequency ratio. Further studies should be focussed towards the comparison of pure L-THE and incorporation within the food matrix to warrant recommendations of L-THE alongside food consumption.

Traditional accounts of the Scottish Enlightenment present the half-century or so before 1750 as, at best, a not yet fully realized precursor to the era of Hume and Smith, at worst, a period of superstition and religious bigotry. This is the first book-length study to systematically challenge that notion. Instead, it argues that the era between approximately 1680 and 1745 was a ‘First’ Scottish Enlightenment, part of the continent-wide phenomenon of Early Enlightenment and led by the Jacobites, Episcopalians, and Catholics of north-eastern Scotland. It makes this argument through an intensive study of the dramatic changes in historiographical practice which took place in Scotland during this era, showing how the documentary scholarship of Jean Mabillon and the Maurists was eagerly received and rapidly developed in Scottish historical circles, resulting in the wholesale demolition of the older, humanist myths of Scottish origins and their replacement with the foundations of our modern understanding of early Scottish history. This volume accordingly challenges many of the truisms surrounding seventeenth- and eighteenth-century Scottish history, pushing back against notions of pre-Enlightenment Scotland as backward, insular, and intellectually impoverished and mapping a richly polymathic, erudite, and transnational web of scholars, readers, and polemicists. It highlights the enduring cultural links with France and argues for the central importance of Scotland’s two principal religious minorities—Episcopalians and Catholics—in the growth of Enlightenment thinking. As such, it makes a major intervention in the intellectual and cultural histories of Scotland, early modern Europe, and the Enlightenment itself.

This chapter argues that the changes which took place in Scottish intellectual culture during the 1680s were not in themselves sufficient to produce this cultural moment. Instead, they interacted with and built upon the rich, long-standing cultural traditions of the north-east, ‘Scotland beyond the mountains’, which are here traced to the foundation of King’s College, Aberdeen, by Bishop William Elphinstone and the early development of a distinctively north-eastern humanist tradition. The scholars and scholarship discussed in the remainder of this book owed their intellectual and cultural world to this heady blend of Early Enlightenment intellectual ferment, revolution, and north-eastern humanism.

On 14 November 1780, David Steuart Erskine, 11th Earl of Buchan, the radical antiquary and natural historian, invited a group of ‘noblemen and gentlemen’ to his house to discuss the formation of what was to become the Society of Antiquaries of Scotland.1 The list is a long and scintillating one, including Lord Kames, Lord Hailes, James Boswell, Gilbert Stuart, and a host of other worthies. Of the thirty-seven invited, however, only fourteen attended....

This chapter interrogates the methods and motivations of a discipline often dismissed as the driest of dry and antiquarian pursuits: genealogy. It reveals that, far from being intellectually vapid, genealogical scholarship was intimately connected to the development of the Stuart state and the transmission of French textual scholarship to Scotland. It offered a proving ground for the new practices of archival research and could practically demonstrate the value of the new scholarship in a field of study whose application was widely seen to be both immediate and essential in a kin-based society.

This chapter explores national and local geographies, challenging older views of this period as a geographically impoverished caesura between the monumental achievements of the 1662 Atlas Maior and the 1791 First Statistical Account. Instead, it argues, geographical scholarship was very much alive during the Early Enlightenment, but was undergoing rapid and unpredictable change as scholars brought new methodologies and new mentalities to bear on a traditional, humanist discipline. It identifies Sir Robert Sibbald as a key figure in early Enlightenment geographical thought while also recovering the works of the forgotten geographers and antiquaries Alexander Keith and Thomas Orem.

This chapter locates the origins of the first Scottish Enlightenment in James VII and II’s patronage in 1680s Edinburgh and the psychological and social impact of the revolution of 1688 on Jacobite, Episcopalian, and Catholic scholars. It closely examines the institutional structures of learned societies, libraries, and churches, demonstrating the ways in which they shaped the agenda of subsequent writers. In doing so, it offers new readings of important moments such as the foundation of the Advocates Library and the ill-fated Catholic presence at Holyroodhouse while offering case studies in the form of the well-known polymath Sir George Mackenzie of Rosehaugh and the more obscure scholar John Cockburn.

This chapter recovers the first major assault on Scotland’s humanist history, its myth of an Ancient Monarchy in the 1680s and the subsequent, increasingly probing challenges which were directed against it in the wake of revolution. The authority of historians such as Hector Boece and George Buchanan was no longer sufficient to protect them from challenges based upon new and more sophisticated interpretations of medieval texts. In particular, Sir George Mackenzie of Rosehaugh’s high-profile dispute with English and Irish scholars such as William Lloyd, Edward Stillingfleet, and Roderick O’Flaherty is identified as a turning point in the development of Scottish historiographical practice.

This chapter assesses the cultural impact of the works of scholarship discussed here. Were they read and, if so, by whom? Using subscription lists, it argues that not only were these texts widely received throughout and furth of Scotland but that their reception allows us to trace the culture of the north-east exporting its own traditions to Scotland at large in a crucial, but subsequently forgotten, moment of cultural and intellectual upheaval. This in turn is placed within the wider context of Early Enlightenment reading, within and beyond the nation. Finally, the conclusion reiterates the arguments of the book as a whole and looks towards the end of the eighteenth century and the fate of Early Enlightenment thought.

The challenges discussed in Chapter 3 culminated in Thomas Innes’s 1729 Critical Essay on the Ancient Inhabitants of the Northern Parts of Britain, or Scotland, the subject of this chapter. Innes’s paradigm-shifting reconstruction of early medieval Scottish history, together with the final rejection of humanist history which it required, still underpins modern understandings of the period. Innes’s own methods and goals, however, were more complex than mere seeking after truth and this chapter interrogates his Jacobite and Catholic, but surprisingly ecumenical agenda as well as tracing the immediate and longer-term fortunes of his theories.

This chapter highlights the foundational role of the French textual scholar Jean Mabillon in setting the agenda for the study of medieval Scotland in the archive during the same period. From the first adoption of Mabillon’s methods by Scottish scholars to the triumphant 1739 publication of James Anderson’s Thesaurus—a Scottish response to Mabillon’s De re diplomatica—these methodologies went from being peripheral to axiomatic in Scottish historical studies, fundamentally transforming scholars’ engagement with the archive and its documents. Key figures discussed include, as well as Anderson, the historians Patrick Abercromby and Robert Keith and the forger and archival scholar Marianus Brockie.

This chapter turns towards artefacts, tracing the sudden rise in interest in prehistoric sites and monuments across Scotland during this period. It shows that cutting-edge approaches to the study of material as diverse as Roman forts and ancient megaliths could interact with older syncretist theories of knowledge and human origins to produce surprising, sometimes radical, reinterpretations of the distant past. Archaeologists and writers as diverse as the opera singer-turned-antiquary Alexander Gordon and the freethinker John Toland used these ancient monuments as telescopes through which to glimpse an almost unimaginable antiquity, one which could exert a dramatically destabilizing effect on present-day hierarchies of culture and geography.

The Early Enlightenment was, in many ways, a time of reckoning and wrestling with Scotland’s humanist past and this was no different for those Scots attempting to build, rebuild, or deconstruct their nation’s literary heritage. This chapter explores a series of canon-building efforts during this period, all growing out of the much older dispute between Scottish and Irish scholars over their shared Gaelic heritage, but all also partaking of new, Enlightened forms of literary scholarship and textual editing to create a distinctive canon of Scottish writers. Key figures discussed include Robert Freebairn, Thomas Ruddiman, Robert Sibbald, and Pierre Bayle.

In the summer of 1699 James Stevenson received an unexpected visitor. Stevenson had been keeper of the Advocates Library, late seventeenth-century Edinburgh’s centre for legal and historical scholarship, since 1693 but now he found himself in the role of novice instead of master. Over two June afternoons his guest, one ‘Mr. Fleming’, taught Stevenson how to date medieval handwriting and even examined many of the library’s manuscripts himself, determining their ages and correcting the descriptions made by Stevenson and his predecessor James Nasmyth. A few days later the stranger had vanished from Edinburgh, leaving Stevenson with only a baffled recollection of an unusually erudite ‘foraign travelled man’....

Peter Burke continues to address wide-ranging issues in the history of knowledge in his latest book, beginning with the bold starting point that ‘[o]ne of the principal aims of this study is to des...

Antiquarianism, the early modern study of the past, occupies a central role in modern studies of humanist and post-humanist scholarship. Its relationship to modern disciplines such as archaeology is widely acknowledged, and at least some antiquaries—such as John Aubrey, William Camden, and William Dugdale—are well-known to Anglophone historians. But what was antiquarianism and how can twenty-first century scholars begin to make sense of it? To answer these questions, the article begins with a survey of recent scholarship, outlining how our understanding of antiquarianism has developed since the ground-breaking work of Arnaldo Momigliano in the mid-twentieth century. It then explores the definition and scope of antiquarian practice through close attention to contemporaneous accounts and actors’ categories before turning to three case-studies of antiquaries in Denmark, Scotland, and England. By way of conclusion, it develops a series of propositions for reassessing our understanding of antiquarianism. It reaffirms antiquarianism’s central role in the learned culture of the early modern world and offers suggestions for avenues which might be taken in future research on the discipline.

Purpose The new Medical College Admission Test (MCAT) was introduced in April 2015. This report presents findings from the first study of the validity of scores from the new MCAT exam in predicting student performance in the first year of medical school (M1). Method The authors analyzed data from the national population of 2016 matriculants with scores from the new MCAT exam (N = 7,970) and the sample of 2016 matriculants (N = 955) from 16 medical schools who volunteered to participate in the validity research. They examined correlations of students' MCAT total scores and total undergraduate grade point averages (UGPAs), alone and together, with their summative performance in M1, and the success rate of students with different MCAT scores in their on-time progression to the second year of medical school (M2). They assessed whether MCAT scores provided comparable prediction of performance in M1 by students' race/ethnicity, socioeconomic background, and gender. Results Correlations of MCAT scores with summative performance in M1 ranged from medium to large. Although MCAT scores and UGPAs provided similar prediction of performance in M1, using both metrics provided better prediction than either alone. Additionally, students with a wide range of MCAT scores progressed to M2 on time. Finally, MCAT scores provided comparable prediction of performance in M1 for students from different sociodemographic backgrounds. Conclusions This study provides early evidence that scores from the new MCAT exam predict student performance in M1. Future research will examine the validity of MCAT scores in predicting performance in later years.

Insights from appraisal well tests can take months to incorporate into subsurface modelling, causing delays to development planning and resulting in key decisions being made using incomplete data and sub-optimal methods. This is due to the time-consuming process of updating or rebuilding reservoir models, simulating them and subsequently analysing the results. In this project, a combination of automated geomodelling, rapid dynamic simulation and statistical analysis were applied to reduce the time to insights from months to days. Well test pressure data was used to condition a suite of reservoir models and evaluate the impact on the optimal development scenario. The application of this process increased confidence in the decision and reduced the modelled probability of low-side outcomes. In addition, we trialled a process to deliver an improvement to the geological understanding of the field through a reduction in the model uncertainties. We also discuss an extension of this concept to perform a robust value-of-information assessment of appraisal or development planning decisions.

Cost-benefit analysis for quality measures has emerged as the cornerstone of CMS' Meaningful Measures initiative.

It is often observed that health care costs in the USA are rising at an “unsustainable” rate. We know that unsustainable trends must stop, but to date, no policy analysts have opined on what will precipitate an end to this one. This article uses scenario analysis to posit potential turning points that could lead to stabilizing spending at a realistic level.

We sought to determine whether receiving major re-selection (MRS) advising benefits undergraduate students' grade-point averages (GPAs). We used a quasi-experimental nonequivalent control group design to compare a treatment group (n = 219) of undergraduates who changed their majors after receiving MRS advising with a control group (n = 206) who changed majors without advising during the same semester as the treatment group. Findings showed that, on average, students who received MRS experienced no change in their program GPA but an increase in their semester GPA; however, the control group experienced a decrease in program and semester GPAs. Multiple regression analysis confirmed that MRS advising had a positive effect on posttest semester GPAs (β = .33, p < .001) and program GPAs (β = .28, p < .001). Implications for student advising are discussed.

Under the Patient Protection and Affordable Care Act (commonly known as ‘Obamacare’), the national uninsured rate has fallen from 17.3 per cent in 2013 to 11.7 per cent in the first half of 2015. While this is a substantial drop, even accounting for the states that did not expand Medicaid, the remaining double-digit national rate, as well as higher rates in some states, indicates that a significant minority of Americans are not buying insurance. Researchers have identified a segment of the population with weak or uncertain preferences for health insurance. This article explores how such individuals are unevenly distributed across states and whether cultural preferences relating to time preference and risk aversion underlie the geographic distribution of the ‘persistently uninsured’. It concludes by reviewing the policy implications presented by the presence of numerous health insurance sceptics in certain jurisdictions.

Multicultural counseling competence (awareness, knowledge, and skills) is necessary to provide effective psychotherapy to an increasingly diverse client population (Sue, 2001). Previous research on predictors of competency among White clinicians finds that above having multicultural training, exposure to racially diverse clients, and social desirability, that White racial identity stages predict multicultural counseling competence (Ottavi et al., 1994). Research also suggests that higher color-blind racial attitudes (denying or minimizing racism in society) correlates with less advanced White racial identity stages (Gushue & Constantine, 2007). However, no studies have examined these variables together as they relate to and possibly predict multicultural counseling competence. The current study aims to add to this literature by investigating the effects of these variables together as potential predictors of multicultural counseling competence among (N = 487) White doctoral students studying clinical, counseling, and school psychology. Results of 3 hierarchical multiple regressions found above the effects of social desirability, demographic variables, and multicultural training, that colorblind racial attitudes and White racial identity stages added significant incremental variance in predicting multicultural counseling knowledge, awareness, and skills. These results add to the literature by finding different predictors for each domain of multicultural competence. Implications of the findings for future research and the clinical training of White doctoral trainees are discussed.

De nombreux etablissements sanitaires et leurs praticiens americains participent aux reformes du systeme de paiement visant a ameliorer la qualite et l’efficience des soins. Mais la libre adhesion des praticiens et des patients aux dispositifs proposes obere l’efficacite a long terme de ces initiatives. Cet article identifie une « norme du volontariat » qui a empeche toute reforme significative du paiement a l’acte tel qu’il existe dans Medicare depuis 1965. Sans aucune menace pour reduire les depenses Medicare telle qu’un systeme de budget global comme le « Sustainable Growth Rate (SGR) », les etablissements sanitaires et leurs praticiens n’ont aucune incitation financiere a long terme a participer aux modeles de paiement alternatifs (Alternative Payment Models — APM) qui instaurent des limitations de leur potentiel de gains. La proposition legislative actuelle, avec ses SGRs volontaires et pas de mecanisme de plafonnement des depenses, ne par viendra pas a realiser une transition d’un paiement aux volumes vers un paiement aux resultats. Cet article analyse les differents comportements developpes par les medecins face a un contexte d’APM volontaire, et les politiques de sante possibles pour une reforme du systeme de paiement plus profonde.

A 15-year-old previously healthy girl presented to the hospital with acute onset fever, epigastric pain, and scleral icterus associated with chills and non-bloody diarrhea. She denied sick contacts, recent travel, or new medications. Family history was significant for a mother with Multiple Sclerosis and a cousin with Crohn's disease (CD). Social history was unremarkable. On arrival, she was febrile to 104 degrees, tachycardic but remained normotensive. On examination, she was nontoxic with obvious scleral icterus. Abdomen was soft, non-distended with RUQ and epigastric tenderness without organomegaly. Murphy's and Rovsing's signs …

Picosecond-scale laser–matter interactions using compound parabolic concentrators have demonstrated strongly relativistic ponderomotive effects with ∼ 10 × increase in x-ray source brightness, positron production and multi-MeV proton acceleration versus flat targets, using a marginally relativistic intensity laser.

Objective Health planning is the process of identifying community needs for health care, facilities and technology and allocating resources to meet those needs to the exclusion of redundant capacity. Health planning in the United States was pioneered in Rochester, New York through private sector efforts but today, health planning is generally understood in the US as referring to a governmental function: “certificate of need” regulation. Yet health planning need not be, and indeed is not today, an exclusively governmental function. The original conception of a health planning agency as a civil society-based, non-governmental organization survives in Rochester. This study assesses the, viability of this private option as an alternative to regulation. Method Outcomes of applications to a, non-governmental health planning entity in the Rochester region (CTAAB) were compared to, outcomes from the state agency (DOH) for two adjacent regions. Results The non-governmental, approach to health planning appeared to be more restrictive, with the Rochester region spending less. There are numerous extraneous commas in the text as it appears on my screen. Are they part of the document? Iif so, they need to be removed. If they were not added to the document, the document does not look right in the Online Proofing application. Overall and in particular, utilizing less advanced imaging. Conclusions The Rochester NY region, appears to demonstrate that cooperative efforts by stakeholders can lower health care costs. For such, voluntary efforts to succeed, policymakers need not regulate—they can engage with community, leaders by convening them to analyze local utilization patterns, review options for chartering or, subsidizing non-governmental organizations to implement planning, and delineate safe harbors from, antitrust or other potential liability arising from collective action