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Explores new doctors' perceptions of their educational development during the first year of postgraduate training. Uses semi-structured open interviews with pre-registration house officers and investigates their views on the importance of their experience to the General Medical Council's competencies. (Author/KHR)

Background Chronic lymphocytic leukaemia ( CLL) is associated with an increased incidence and aggressiveness of skin cancers, particularly cutaneous squamous cell carcinoma ( cSCC), but little is known about cSCC incidence in Australasian CLL patients. Aim In this retrospective study, we analysed the incidence of cSCC in patients seen at a tertiary hospital in New Zealand ( NZ). Methods We retrospectively assessed the clinical history and histology data of CLL patients ( n = 371) who presented to the Haematology Department, Christchurch Hospital, NZ during the period 1996-2015. Baseline characteristics, incidence of second cancers, treatment details and overall survival were analysed. Results During follow-up (median = 11.8 years), 221 second cancers were recorded in 88 patients. Of these cancers, 185 were cSCC, removed from 61 patients. In 56% of these patients, >1 cSCC was removed, and the majority of cSCC occurred following the treatment for CLL. The cumulative incidence of a first cSCC was 11% at 5 years, whereas the cumulative incidence of a subsequent cSCC was 88% at 5 years. The incidence of cSCC in male patients was threefold higher than that reported for the general NZ population. Conclusion NZ CLL patients have a high incidence of cSCC relative to the levels observed in the general population, which are themselves among the highest in the world. The careful monitoring of CLL patients is warranted, particularly those who have a progressive disease or have had a first cSCC removed. [ABSTRACT FROM AUTHOR]

As the number of plug-in hybrid vehicles (PHEVs) increases, so might the impacts on the power system performance, such as overloading, reduced efficiency, power quality, and voltage regulation particularly at the distribution level. Coordinated charging of PHEVs is a possible solution to these problems. In this work, the relationship between feeder losses, load factor, and load variance is explored in the context of coordinated PHEV charging. From these relationships, three optimal charging algorithms are developed which minimize the impacts of PHEV charging on the connected distribution system. The application of the algorithms to two test systems verifies these relationships approximately hold independent of system topology. They also show the additional benefits of reduced computation time and problem convexity when using load factor or load variance as the objective function rather than system losses. This is important for real-time dispatching of PHEVs. [ABSTRACT FROM PUBLISHER]

The article argues for planning care with all people who have an advanced illness and in all care settings. Topics discussed are the challenge face by people with advance illnesses or deteriorating health conditions, the uncertainty of the benefits of treatment as a barrier for professionals and policymakers, and the strategy for addressing prognostic uncertainty in advancing illness involving making predictions about the likelihood of a person to die so as to start end-of-life care.

Safe and effective sedation for the pediatric patient while undergoing magnetic resonance imaging (MRI) is essential. Monitoring of the pediatric patient is essential not only during the MRI procedure, but also during the recovery period after the examination. Capnography, which measures end-tidal carbon dioxide (ETCO2), is a routine part of anesthesia practice for general anesthesia that also works well for the sedated patient in the imaging department. This study assessed the use of ETCO2 in the recovery area to monitor the pediatric patient after being sedated with intravenous (IV) pentobarbital while in the MRI scanner. The results of this study showed that ETCO2 levels remained within the clinical normal range throughout the recovery period for pediatric patients sedated with IV pentobarbital. [ABSTRACT FROM AUTHOR]

Half-hourly GPS zenith tropospheric delay (ZTD) and collocated surface weather observations of pressure, temperature, and relative humidity are available in near–real time from the NOAA Global Systems Division (GSD) research GPS receiver network. These observations, located primarily over the continental United States, are assimilated in a research version of the Environment Canada (EC) regional (North America) analysis and forecast system. The impact of the assimilation on regional analyses and 0–48-h forecasts is evaluated for two periods: summer 2004 and winter 2004/05. Forecasts are verified against radiosonde, rain gauge, and NOAA GPS network observations. The impacts of GPS ZTD and collocated surface weather observations for the summer period are generally positive, and include reductions in forecast errors for precipitable water, surface pressure, and geopotential height. It is shown that the ZTD data are primarily responsible for these forecast error reductions. The impact on precipitation forecasts is mixed, but more positive than negative, especially for the central U.S. region and for forecasts of larger precipitation amounts. Assimilation of the collocated surface weather data with ZTD contributes to the positive impact on precipitation forecasts for the central U.S. region. The NOAA GPS network data also have a positive impact on tropical storm system forecasts over the southeast United States, in terms of both storm track and precipitation. Impacts for the winter case are generally smaller because of the lower precipitable water (PW) over North America, but some positive impacts are observed for precipitation forecasts. The greatest regional impacts in the winter case are observed for the southeast U.S. (the Gulf) region where average PW is highest. [ABSTRACT FROM AUTHOR]

As part of a larger study on learning outcomes for the first year of postgraduate medical training (already reported), semi-structured interviews with middle grade trainees were used to explore their perceptions of trainee development during this first training year. Data generated focused not only on learning outcomes, but also on important process issues. Dissatisfaction was expressed with formal and informal teaching and learning opportunities. Factors that enhance the learning environment were identified. These included being supported, a feeling of being a valued member of the team, being stretched but not over stretched, having a broad range of experiences, knowing the system, having a clear remit and being well organized. Factors inhibiting the learning environment included fractured working patterns, insufficient time with patients and seniors, as well as the converse of many of the enhancing factors. The process issues gathered in this paper will be of interest to those involved in the delivery of training for junior doctors. [ABSTRACT FROM AUTHOR]

To evaluate potential learning outcomes for pre-registration house officer (PRHO) training and develop an evidence base for informed decision making. A 2-stage Delphi process was employed to establish the opinions of Scottish stakeholders with regard to learning outcomes for the PRHO year. Doctors involved in the provision of PRHO training, including deans, postgraduate tutors and general practitioners (GPs) with trainees, were invited to participate in the study. Respondents rated a range of outcomes according to which they believed should be included or excluded from the PRHO training year. Learning outcomes identified for PRHOs were grouped under the 12-domain framework of the 3-circle model: ‘What the doctor can do’, ‘How they approach their practice’ and ‘Their professionalism’. Based on the consensus opinions gained in the Delphi study, the ratings were classified into priority groupings. Priority 1 contained 45 of the original 81 learning outcomes, representing each area of the 3-circle model, with emphasis on the domains of clinical skills, patient investigation/management, communication, appropriate attitudes and personal development. Health promotion and disease prevention was the only domain not represented at priority 1. Priority 2 contained 24 outcomes with emphasis on the understanding of clinical skills, patient management and personal development. Priority 3 contained 12 outcomes indicating a lack of emphasis for some outcomes, particularly the role of the doctor and health promotion. Consensus on the learning outcomes for PRHO training has been achieved, providing an evidence base for curriculum planning. The relative priority assigned to these outcomes can facilitate the use of the evidence. This evidence base should be referred to when reviewing any PRHO training programme. [ABSTRACT FROM AUTHOR]

The 2010 Deepwater Horizon (DWH) oil spill and associated response activities overlapped with habitats for multiple life stages of federally protected sea turtles in the northern Gulf of Mexico. Although most assessment efforts focused on documenting the presence, abundance, and exposure of sea turtles to DWH oil in marine habitats, oil also washed ashore on sand beaches used by nesting turtles, specifically in NW Florida and Alabama, USA. In addition, extensive and highly mechanized beach cleanup efforts were conducted in NW Florida as well as Alabama, Louisiana, and Mississippi. Thus, the DWH oil spill negatively affected sea turtle nesting directly (e.g. adverse effects of oil exposure) and indirectly (e.g. beach cleanup activities deterring nesting) in several ways. In this study, we used a before-after, control-impact statistical modeling approach to examine long-term (1997-2012) historical records of loggerhead turtle (Caretta caretta) nest densities in 2 segments of the Florida Gulf coastline, one that was heavily affected by the oil spill (NW Florida) and one that was relatively unaffected (SW Florida). Loggerhead nest densities on NW Florida beaches in 2010 were reduced by 43.7% (95% confidence interval: 10-65%) relative to expected nesting rates in the absence of DWH oil and cleanup efforts. When we applied this reduction to all nesting habitat in NW Florida, this equated to a loss of approximately 251 unrealized nests from the 2010 nesting seasonóa loss we attribute to direct (e.g. mortality) and indirect (e.g. deterrence of nesting) effects related to the DWH incident.

Oestrogen action is mediated via specific receptors that act as ligand-activated transcription factors. A monoclonal antibody specific to the C-terminus of human oestrogen receptor beta has been characterized and the prevalence of expression of oestrogen receptor beta protein investigated in a well defined set of breast cancers. Reverse transcription-polymerase chain reaction analysis of RNA from tissue biopsies detected oestrogen receptor beta in all samples examined. The anti-oestrogen receptor beta antibody cross reacted specifically with both long (approximately 59 Kd) and short (approximately 53 Kd) forms of recombinant oestrogen receptor beta. Western blot analysis of breast tumours contained both forms of oestrogen receptor beta protein although in some samples lower molecular weight species (32--45 Kd) were identified. Fifty-one breast cancer biopsies were examined using immunohistochemistry; 41 (80%) were immunopositive for oestrogen receptor alpha, 48 (94%) were immunopositive for oestrogen receptor beta and 38 (74.5%) co-expressed both receptors. Expression of oestrogen receptor beta was exclusively nuclear and occurred in multiple cell types. There was no quantitative relationship between staining for the two ERs although in tumours in which both receptors were present immunoexpression of oestrogen receptor alpha was invariably more intense. The significance of oestrogen receptor beta protein expression in breast cancers to therapy remains to be determined but the availability of a well characterized antibody capable of detecting oestrogen receptor beta in archive material will facilitate the process. [ABSTRACT FROM AUTHOR]

- Malignant phaeochromocytoma is a rare tumour and experience in its management is therefore limited. Five patients are discussed in whom the development of metastases was associated with rapidly progressive disease. [ABSTRACT FROM AUTHOR]

This study investigates the 'typical' form of design description for heating, ventilating and air conditioning systems in buildings at a point in the design development corresponding to the feasibility stage of the Royal Institute of British Architects' plan of work. Eight case studies yielded rich qualitative data on the form of design description and the process by which those designs evolved. It was found that the designs developed with a fragmentary attention to detail, and did not conform to the top-down approach to design management implied by the plan of work or other prescriptive models of design. Nevertheless, patterns which emerged from the data imply that the design process behind this is not entirely idiosyncratic and unstructured, but points to a strategic approach in the use of detail which was shared by the designers. An empirical model of this strategic process, grounded in the data from the study (a 'grounded theory' model), is developed and the implications for builders of more general models of the design management process are discussed. [ABSTRACT FROM AUTHOR]

When the people which spread the Brahminical religion and institutions from the valley of the Ganges, extended them, by migration and conquest, over the Indian peninsula, large portions of the primitive population remained unsubdued and unconverted where physical circumstances specially favoured their resistance to force and to the pressure of moral influences; and, accordingly, numerous remnants of them are now seen, scattered widely under the most various aspects, and often under highly interesting relations to the dominant people. [ABSTRACT FROM PUBLISHER]

Thirty-three patients with end-stage renal failure have had transplants over a three-year period, four patients receiving kidneys from siblings and the remainder cadaver organs. Twenty-seven kidneys survived with stable function for periods of six months to three years. Graft survival at one year was 85% and at two years 82%. One patient died and five were returned to dialysis. Complications included rejection episodes, technical problems, respiratory and wound infections, gastrointestinal disorders, and side effects of steroids. [ABSTRACT FROM PUBLISHER]

Following surgical resection of Dukes' B or C colorectal cancers 72 patients have been randomly allocated to receive: 5-fluorouracil; or 5-fluorouracil and levamisole; or no treatment. Adjuvant treatment was continued for one year. 66 patients remain evaluable for up to 24 months. Preliminary results show no significant differences in survival or recurrence rates. Two patients receiving 5-fluorouracil and levamisole developed severe, but reversible, neutropenia. Other side effects were uncommon. [ABSTRACT FROM AUTHOR]

This case report summarizes the course of events leading to diagnosis and eventual repair of anterior cutaneous nerve entrapment syndrome (ACNES) in a 58-year-old female. The time period elapsing from initial symptoms to final operative repair was 9 months. The diagnosis was missed by both medical and surgical specialists despite multiple outpatient appointments, investigative procedures and a battery of laboratory tests. The diagnosis of ACNES was first considered when reviewed by a hernia surgeon and subsequently confirmed following open exploration of the anterior abdominal wall. The nerve was released and pain symptoms resolved. Access to the NHS Scotland ISD register permitted an economic analysis of the diagnostic services utilized for this patient and these totalled nearly £11 500. At a time when the NHS is focused on cost effectiveness, this particular sequence of investigations illustrates a protracted and costly diagnostic pathway. [ABSTRACT FROM AUTHOR]