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This article was migrated. The article was marked as recommended. Medical schools are responsible for producing the future medical workforce that is fit for purpose to meet the needs of patients. The burden of care largely falls upon primary care, a specialty which has been under-doctored, under-resourced, culturally not valued, and whose status has been subordinate to secondary care. In addition, the demographic changes of increasing longevity and chronic diseases, have increased the demand for healthcare at a time when governments' finances are stretched more than ever. The poor state of recruitment to the primary care workforce is a global phenomenon as evidenced by similar issues in North America, UK and the Middle East including Turkey. This contradicts the fact that the strength of primary care has a direct effect on the health of the nation. This paper presents an international perspective of why primary care is important, the reasons why new graduates shy away from a career in primary care, and what steps medical schools, residency programmes and governments should undertake to encourage medical students to make primary care a preferred career choice., (Copyright: © 2020 Sandhu D et al.)

The simulated surgery examination is one of the tripos of entry assessments for the Induction and Refresher (I&R) Scheme. It is used to assess the clinical and consulting skills of GPs prior to a period of supervised practice. The assessment involves observing candidates consulting with simulated patients played by role-players presenting standardised cases. Additionally, this assessment provides an 'educational prescription' for both passing and failing candidates as well as evidence of linguistic competency for overseas candidates. A feedback questionnaire is administered to candidates immediately after the examination, to seek their views and to evaluate their experience of the exam. Between July 2015 and July 2018, 401 candidates completed the examination and questionnaire. Quantitative and qualitative data has been collected and analysed with the findings reported in this paper. Overall candidates are satisfied with the examination, and regard it as a valid assessment of their GP consulting skills. However, there are still concerns regarding the I&R application process although there is evidence that there has been a trajectory of improvement over the past three years. Candidate feedback obtained has been used in an iterative manner to ensure quality control of the examination as well as for prompting improvements in the process.

Metallic silver nanowires with high yield were synthesized using a modified seed mediated approach at room temperature. Ribbon-like nanostructures were obtained when the concentration of NaOH was lower and further increase of NaOH transformed it into long nanowires. These nanowires possess high aspect ratio, with length and diameter ~6.5 μm and 17 nm respectively. The surface enhanced Raman scattering activity of these nanowires was tested with three different probe molecules viz., crystal violet, malachite green and nile blue chloride using visible (514.4 nm) and near-infrared (784.8 nm) excitation lines. The minimum detection limits for crystal violet and nile blue chloride molecules were found to be down to 10 -7  M with good linear responses, as evidenced by values of correlation coefficients, indicating their potential for a variety of applications such as sensing. Principal component analysis was performed with the surface enhanced Raman spectra in order to discriminate the dye molecules and their mixture, simultaneously. The first two principal components, which provided 69.80 and 27.93% of the total data variance, could be conveniently represented as a two dimensional PCA score plot. The score plot showed clear clustering of probe molecules and their mixture. The relative contribution of wavenumbers to each of the two principal components was identified by plotting the PCA loading matrix. These results further promote possibilities of quantification of multiplexed SERS detection and analysis., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Social phobia is a common psychiatric disorder, and its onset happens usually around late adolescence period. Therefore, early diagnosis and its management is essential in any educational setting., Objectives: To identify university students with social phobia, to find out its determinants and to observe its impact on their quality of life., Methods: The data was collected using a self-administered questionnaire. Social Phobia Inventory Questionnaire and Quality of Life Enjoyment and Satisfaction Questionnaire were used., Results: The mean age of the 450 student participants was 20.6 ± 1.6 years. Majority [312(69.3%)] were males and majority [305(67.8%)] were native of urban areas. Of the total, 169(37.6%) were found to have social phobia. Among them, 114(67.5%) had mild, 47(27.8%) had moderate and 8(4.7%) had severe social phobia. Family history of anxiety disorders (P = 0.006), embarrassment with own socio-economic status (P = 0.001) and past history of failure in academic examinations (P < 0.001) were significantly associated with the presence of social phobia among the participants. Preference of interaction using social media instead of face to face communication with people (P = 0.013), and by texting rather than calling the person (P = 0.002) were seen significantly more among those with social phobia. The mean quality of life scores was found to be deteriorating significantly with increasing intensity of social phobia among students (P < 0.001)., Conclusion: Social phobia was seen among more than one-third of the participants. Counselling centers are therefore required to address this problem at universities. This will also help to improve the quality of life and the socializing skills of those affected., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This article reports on the luminescence properties of rare earth (Dy 3 + and Tm 3 + )ions doped SrGa 2 Si 2 O 8 phosphor were studied. SrGa 2 Si 2 O 8 phosphors weresynthesizedby employing solid state reaction method.From the measured X-ray diffraction (XRD) pattern of the samplemonoclinic phase structure has been observed. Thermoluminescenceand Mechanoluminescence properties of the γ-ray irradiated samples have been studied. Photoluminescence spectra of Dy 3 + activated SrGa 2 Si 2 O 8 phosphor has been measured with an excitation wavelength at 348 nm,and it shows two emission bands at 483 and 574 nm due to 4 F 9 /2  →  6 H 15 /2 and 4 F 9 /2  →  6 H 13 /2 transitions respectively. Whereas the photoluminescence spectra of Tm 3 + activated SrGa 2 Si 2 O 8 phosphor has been measured with an excitation wavelength at 359 nm and it exhibits two emission bands at 454 and 472 nm due to 1 D 2  →  3 F 4 and 1 G 4  →  3 H 6 transitions respectively. In thermoluminescence study, γ-irradiatedthermoluminescence glow curve of SrGa 2 Si 2 O 8 :Dy 3 + phosphor shows two well defined peaks at 293 °C (peak1)and 170 °C (peak2) whereas thermoluminescence glow curve of SrGa 2 Si 2 O 8 :Tm 3 + phosphor shows peaks at 292 °C (peak1) and 184 °C (peak2) indicating that two sets of traps are being activated within the particular temperature range and the trapping parameters associated with the prominent glow peaks of SrGa 2 Si 2 O 8 :Dy 3 + and SrGa 2 Si 2 O 8 :Tm 3 + are calculated using Chen's peak shape and initial rise method.From the Mechanoluminescence study, only one glow peak has been observed. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

LaBO 3 :xDy 3+ (x = 0.05 mol%, 0.1 mol%, 0.2 mol%, 0.5 mol%, 1 mol% and 2 mol%) phosphors were synthesized by solid-state reaction method. X-ray diffraction technique was used to confirm the formation of compound. Photoluminescence emission spectra shows two emission peaks at 470 nm and 575 nm when excitation wavelength is set at 352 nm. Photoluminescence intensity increases upto 1 mol % of Dy 3+ and then starts decreasing. Dipole-dipole interaction is found to be responsible for concentration quenching of photoluminescence intensity. Commission Internationale de I'Eclairage (CIE) chromaticity diagram demonstrates that the phosphor emits in bluish white region of the visible spectrum. Critical energy transfer distance between dopant ions was determined. The mechanoluminescence characteristics were studied by the impact method. The peaks of both the mechanoluminescence (ML) intensity and the total ML intensity of the UV exposed phosphors increases with increasing impact velocity for 1 mol % concentration of Dy 3+ . The ML sensitivity of the LaBO 3 :Dy 3+ (Dy 3+  = 1 mol %) phosphor is comparable with the reported ML of various inorganic phosphors. The thermoluminescence characteristics of the samples were also investigated. Thermoluminescence glow peaks were recorded with 480 Gy, 80 Gy and 20 Gy dose of γ-irradiation from Co 60 Source. TL trapping parameters were determined by Chen's peak shape method and glow curve deconvolution method. LaBO 3 :Dy 3+ phosphors were found to be good mechanoluminescent materials and can be used in stress sensing application.

Background: The use of administrative data for surgical site infection (SSI) surveillance leads to inaccurate reporting of SSI rates [1]. A quality improvement (QI) initiative was conducted linking clinical registry and administrative databases to improve reporting and reduce the incidence of SSI [2]., Methods: At our institution, The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and infection surveillance database (ISD) were linked to the enterprise data warehouse containing electronic health record (EHR) billing data. A data visualization tool was created to (1) use the STS-CHSD for case ascertainment, (2) resolve discrepancies between the databases, and (3) assess impact of QI initiatives, including wound alert reports, bedside reviews, prevention bundles, and billing coder education., Results: Over the 24-month study period, 1,715 surgical cases were ascertained according to the STS-CHSD clinical criteria, with 23 SSIs identified through the STS-CHSD, 20 SSIs identified through the ISD, and 32 SSIs identified through the billing database. The rolling 12-month STS-CHSD SSI rate decreased from 2.73% (21 of 769 as of January 2013) to 1.11% (9 of 813 as of December 2014). Thirty reporting discrepancies were reviewed to ensure accuracy. Workflow changes facilitated communication and improved adjudication of suspected SSIs. Billing coder education increased coding accuracy and narrowed variation between the 3 SSI sources. The data visualization tool demonstrated temporal relationships between QI initiatives and SSI rate reductions., Conclusions: Linkage of registry and infection control surveillance data with the EHR improves SSI surveillance. The visualization tool and workflow changes facilitated communication, SSI adjudication, and assessment of the QI initiatives. Implementation of these initiatives was associated with decreased SSI rates., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Li3 PO4 phosphors prepared by solid-state diffusion technique and lyoluminescence (LL) as well as mechanoluminescence (ML) studies are reported. Dy- and Tb-activated phosphors show dosimetric characteristics using LL and ML techniques. The energy levels and hence trapping and detrapping of charge carriers in the material can be studied using ML. Li3 PO4 phosphor can be used in the dosimetric applications for ionizing radiation. By using the LL technique, the LL characteristics of Li3 PO4 may be useful for high radiation doses. We also report a more detailed theoretical understanding of the mechanism of LL and ML., (Copyright © 2014 John Wiley & Sons, Ltd.)

Li3 PO4 phosphor was prepared using a modified solid-state diffusion technique. In this work, photoluminescence, lyoluminescence and mechanoluminescence studies were carried out in a Li3 PO4 microcrystalline powder doped with different rare earths. In photoluminescence studies, characteristic emission of Ce and Eu was observed. The lyoluminescence glow curves of Li3 PO4 microcrystals show that lyoluminescence intensity initially increases with time and then decreases exponentially. The decay time consists of two components for all masses. The dependence of decay time, especially the longer component, on mass has been investigated. Experiments on γ-irradiated crystals have proved that the light emission originates from the recombination of released F-centres with trapped holes (V2-centres) at the sulfuric acid-solid interface. Incorporation of bivalent alkali in solid lithium phosphate leads to an enhancement of lyoluminescence. A possible explanation for the experimental results has been attempted. The phosphor has a mechanoluminescence single glow peak. Mechanoluminescence intensity under various loading conditions was investigated. It is observed that mechanoluminescence intensity increases with increasing impurity concentration and increasing piston impact velocity. The results may be considered as only being of academic interest in solid-state materials., (Copyright © 2013 John Wiley & Sons, Ltd.)

An abundance of evidence exists in support of primary and secondary prevention for tackling the scourge of cardiovascular disease. Despite our wealth of knowledge, certain deficiencies still remain. One such example is the association between sleep disordered breathing (SDB) and cardiovascular disease. A clear body of evidence exists to link these two disease entities (independent of other factors such as obesity and smoking), yet our awareness of this association and its clinical implication does not match that of other established cardiovascular risk factors. Here, we outline the available evidence linking SDB and cardiovascular disease as well as discussing the potential consequences and management in the cardiovascular disease population.

A substantial proportion of patients who undergo cardiac rhythm device implantation receive anticoagulation to prevent thromboembolism. Many patients have coexisting cardiovascular diseases treated with antiplatelet therapy. Anticoagulation may increase the risk of hemorrhagic complication, while withdrawal of anticoagulation may increase thromboembolic risk. In this article, we review and describe the available evidence, in order to inform best practice .

Agar is a biological polymer, frequently used in tissue engineering research; due to its consistency, controllable size, and concentration-based properties, it often serves as a representative material for actual biological tissues. In this study, nanoindentation was used to characterize both the time-independent and time-dependent response of agar samples having various concentrations (0.5%-5.0% by weight). Quasi-static indentation was performed at different loads and depths using both open- and closed-loop controls. Reduced modulus (Er) values change with agar concentration, ranging from ∼30 kPa for 0.5% samples to ∼700 kPa for 5.0% samples, which is the same modulus range as usually encountered in soft biological materials. Dynamic indentation was performed to assess the effects of load, dynamic frequency and amplitude. Storage modulus values ranged from approximately 30 to 2300 kPa depending on agar concentration. Loss modulus remained consistently less than 30 kPa at all conditions, indicating a diminished damping response in agar., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The temperature and mass dependence of lyoluminescence intensity of γ-irradiated colored potassium chloride powder have been studied using a photomultiplier tube connected to an x-y recorder. The peak lyoluminescence intensity increases with increasing amount of solute added up to 50 mg and then tends to saturate. The lyoluminescence (LL) glow curves with mass of KCl microcrystals show that initially the LL intensity increases with time and then decreases exponentially with time. The decay time consists of two components for all the masses. The dependence of decay time, especially the longer component on mass, has been investigated. The temperature dependence of LL intensity shows that initially the peak LL intensity increases with temperature up to 60°C, and then decreases with further increase in temperature. The decay time tends to decrease with increasing temperature. An explanation for the experimental results has been attempted., (Copyright © 2010 John Wiley & Sons, Ltd.)

A 79-year-old man presented with relapse of non-Hodgkin's B-cell lymphoma within the scar from his implantable cardioverter defibrillator (ICD) implantation. The ICD was re-sited before he proceeded to chest wall radiotherapy, which resulted in complete remission of the lymphoma. This is the first reported case of lymphoma recurrence within an ICD wound scar.

The number of cardiac resynchronization therapy (CRT) device implantations has been increasing exponentially, with the implant rate doubling over the past few years. While the majority of CRT recipients enjoy symptomatic relief, approximately 30% of individuals reap no benefit and only a minority are rendered completely symptom free. In response, many clinicians engage in the theoretically advantageous process of postimplantation optimization of atrial and ventricular stimulation by altering atrioventricular and interventricular pacing intervals. However, the rationale for routine CRT optimization and the methods of doing so have been the subjects of recent debate. Here, we present an overview of the background, techniques and evidence for CRT optimization.

Heart failure is posing an increasing burden on healthcare systems around the world, a consequence of increased survival from acute coronary syndromes and life-prolonging medications. Cardiac resynchronization therapy has become a ratified and established therapy for heart failure to reduce both the morbidity and mortality of the condition. Its prophylactic role in patients who have minimal symptoms to delay future deterioration is a novel development. The indications for this therapy continue to evolve, mainly as a result of company-sponsored multicenter trial data aimed at broadening its usage. Uncertainty remains on how to accurately identify individuals who will respond to resynchronization therapy and how best to manage patients following device implant.

This article examines interest in massage therapy and other forms of complementary and alternative medicine among patients with breast disease. Surveys were mailed to 63 patients who had a breast abnormality or a recent diagnosis of breast cancer and received complimentary massage therapy at Mayo Clinic in Rochester, MN, from February to April 2005. Thirty-five patients responded (56% response rate). All participants felt that massage therapy was effective in helping them relax, and 34 felt that it was very or somewhat effective in reducing muscle tension. More than 75% reported that massage therapy was effective in reducing fatigue, creating a general feeling of wellness, and improving sleep quality and their ability to think clearly. Although this study was small, the findings show that massage therapy may help patients with breast disease relax and feel better overall.

Infrared and Raman spectra of four rare earth (Ho, Eu, Nd and Pr) double sulphates have been recorded and analysed based on the vibrations of methyl ammonium cations, sulphate anions and water molecules. Formation of hydrogen bonds of the type N-H...O and O-H...O are identified in all the compounds. Bifurcated hydrogen bonds are present in the compounds with dimethyl ammonium cations. The sulphate anions are distorted and occupy a lower site symmetry in the compounds. The bands obtained for (CH(3))(2)NH(2) and SO(4)(2-) ions indicate that the structural bonding of (CH(3))(2)NH(2)Eu(SO(4))(2).H(2)O and (CH(3))(2)NH(2)Ho(SO(4))(2).4H(2)O is identical. Electronic transition bands of Eu(3+) and Nd(3+) observed in the Raman spectra of these two compounds have been identified and discussed.

Polarized Raman spectral changes with respect to temperature were investigated for Pr(BrO3)3.9H2O single crystals. FTIR spectra of hydrated and deuterated analogues were also recorded and analysed. Temperature dependent Raman spectral variation have been explained with the help of the thermograms recorded for the crystal. Factor group analysis could propose the appearance of BrO3 ions at sites corresponding to C3v (4) and D3h (2). Analysis of the vibrational bands at room temperature confirms a distorted C3v symmetry for the BrO3 ion in the crystal. From the vibrations of water molecules, hydrogen bonds of varying strengths have also been identified in the crystal. The appearance upsilon1 mode of BrO3- anion at lower wavenumber region is attributed to the attachment of hydrogen atoms to the BrO3- anion. At high temperatures, structural rearrangement is taking place for both H2O molecule and BrO3 ions leading to the loss of water molecules and structural reorientation of bromate ions causing phase transition of the crystal at the temperature of 447 K.

Raman and FTIR spectra of [Cu(H2O)6](BrO3)2 and [Al(H2O)6](BrO3)3 x 3H2O are recorded and analyzed. The observed bands are assigned on the basis of BrO3- and H2O vibrations. Additional bands obtained in the region of v3 and v1 modes in [Cu(H2O)6](BrO3)2 are due to the lifting of degeneracy of v3 modes, since the BrO3- ion occupies a site of lower symmetry. The appearance v1 mode of BrO3- anion at a lower wavenumber (771 cm(-1)) is attributed to the attachment of hydrogen to the BrO3- anion. The presence of three inequivalent bromate groups in the [Al(H2O)6](BrO3)3 x 3H2O structure is confirmed. The lifting of degeneracy of v4 mode indicates that the symmetry of BrO3- anion is lowered in the above crystal from C3v to C1. The appearance of additional bands in the stretching and bonding mode regions of water indicates the presence of hydrogen bonds of different strengths in both the crystals. Temperature dependent Raman spectra of single crystal [Cu(H2O)6](BrO3)2 are recorded in the range 77-523 K for various temperatures. A small structural rearrangement takes place in BrO3- ion in the crystal at 391 K. Hydrogen bounds in the crystal are rearranging themselves leading to the loss of one water molecule at 485 K. This is preceded by the reorientation of BrO3- ions causing a phase transition at 447 K. Changes in intensities and wavenumbers of the bands and the narrowing down of the bands at 77 K are attributed to the settling down of protons into ordered positions in the crystal.

FTIR and single crystal Raman spectra of (CH3)2NH2Al(SO4)2 x 6H2O have been recorded at 300 and 90 K and analysed. The shifting of nu1 mode to higher wavenumber and its appearance in Bg species contributing to the alpha(xz) and alpha(yz) polarizability tensor components indicate the distortion of SO4 tetrahedra. The presence of nu1 and nu2 modes in the IR spectrum and the lifting of degeneracies of nu2, nu3, and nu4 modes are attributed to the lowering of the symmetry of the SO4(2-) ion. Coincidence of the IR and Raman bands for different modes suggest that DMA+ ion is orientationally disordered. One of the H atoms of the NH2 group of the DMA+ ion forms moderate hydrogen bonds with the SO4(2-) anion. Al(H2O)6(3+) ion is also distorted in the crystal. The shifting of the stretching modes to lower wavenumbers and the bending mode to higher wavenumber suggest that H2O molecules form strong hydrogen bonds with SO4(2-) anion. The intensity enhancement and the narrowing of nu1SO4, deltaC2N and Al(H2O)6(3+) modes at 90 K confirm the settling down of the protons in the hydrogen bonds formed with H2O molecules and NH2 groups. This may be one of the reasons for the phase transition observed in the crystal.

Using a research technique that combines a quantitative method adapted from linguistic science and conventional qualitative methods, the authors explore consumers' understanding of key terms--"primary care" vs. "family care," "hospital" vs. "medical center," and "aesthetic" vs. "cosmetic"--used in names for health care services. Their results reveal semantic differences that clearly point to names that optimally position these medical services in the local and regional marketplace.