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We propose a robustness testing approach for software systems that process large amounts of data. Our method uses metamorphic relations to check software output for erroneous input in the absence of a tangible test oracle. We use this technique to test two major citation database systems: Scopus and the Web of Science. We report a surprising finding that the inclusion of hyphens in paper titles impedes citation counts, and that this is a result of the lack of robustness of the citation database systems in handling hyphenated paper titles. Our results are valid for the entire literature as well as for individual fields such as chemistry. We further find a strong and significant negative correlation between the journal impact factor (JIF) of IEEE Transactions on Software Engineering (TSE) and the percentage of hyphenated paper titles published in TSE. Similar results are found for ACM Transactions on Software Engineering and Methodology. A software engineering field-wide study reveals that the higher JIF-ranked journals are publishing a lower percentage of papers with hyphenated titles. Our results challenge the common belief that citation counts and JIFs are reliable measures of the impact of papers and journals, as they can be distorted simply by the presence of hyphens in paper titles.

Land supply for new housing in the established middle-suburbs (greyfields), where much urban infill potential exists, is “locked up” due to restrictive land-use regulation. As a result, most reside...

Objectives: The aim was to explore the experiences of fourth-year medical students of diagnostic consultations in a simulated primary care setting, in order to gain an insight into the suitability of such simulated consultations for assessing the diagnostic reasoning skills of medical students.\ud \ud Methods: This single-centre study employed a qualitative, cross-sectional design. Twelve fourth-year medical students volunteered to be filmed across 21 simulated, primary care consultations. The setting closely resembled OSCE stations, with a clinician present at each station monitoring the students’ performance using a station-checklist. Upon completion of each station, participants reflected on their experiences using video-stimulated recall. Interviews were transcribed and analysed using Interpretative Phenomenological Analysis.\ud \ud Results: The simulated scenarios were often perceived to have limited fidelity with predictable outcomes. At times, preoccupation with the assessment checklist meant that students were more likely to focus on asking questions than interpreting the information they were gaining. Some students felt scrutinized during the consultations, while others struggled to adapt to the time pressure. Overall, the artificial setting seemed to promote a reductionist diagnostic approach and an attitude of ‘ticking boxes’ rather than engaging in active diagnostic reasoning.\ud \ud Conclusions: The present findings call into question the assumption that observation-based assessment of the performance of medical students during simulated consultations can be reliably used to assess their diagnostic skills. Future studies need to explore how current assessment modalities could be better adapted to facilitate active engagement in diagnostic reasoning.

Viewing the Invisible is a multimedia collaboration that explores common methodology between arts and sciences. Portraits of science influencers were painted while dialogue between artist and subject was filmed. Here, we show the implementation of our recent exhibition as a model that can be adapted for use elsewhere in public or school settings to challenge misconceptions about the role of creativity in science and technical precision in art., This Community Page article describes “Viewing the Invisible,” a multimedia collaboration where artists painted portraits of scientists, mutually discovering the creativity of science and the technical precision of art.

Productivity growth has declined in most advanced economies in the past two decades and there are signs that the pace of global value chain (GVC) integration has slowed in the post-crisis period. This paper explores the role of GVCs - international trade in intermediate inputs - for multi-factor productivity growth using a range of cross-country industry-level data sources. We find that greater participation in GVCs is associated with faster domestic productivity growth at the industry level. We estimate that if GVCs had continued to grow at their pre-crisis trend, productivity growth would have been around 1 percentage point faster over the subsequent five years in both manufacturing and services. We also find that the productivity-enhancing direction of trade differs between sectors. For manufacturing sectors, greater use of intermediate inputs from foreign sources (backward participation) is linked with faster productivity growth, reflecting the beneficial effects of having access to better quality or cheaper inputs. For services sectors, it is more the sales of intermediates (forward participation) that is associated with productivity gains, in line with the traditional role of services in foreign trade as providing inputs to other activities. Looking by partner country, GVC participation with higher productivity countries is particularly productivity enhancing. We also find that GVC integration spurs greater domestic innovation activity.

Purpose: To determine the elicitation methodologies best placed to uncover and capture the expert operator’s reflective cognitive judgements in complex and dynamic military operating environments (e.g., explosive ordinance disposal) in order to develop the specification for a reflective eXplainable Artificial Intelligence (XAI) agent to support the training of domain novices. Approach: A bounded literature review of the latest developments in expert knowledge elicitation was undertaken to determine the ’art-of-the-possible’ in respects to uncovering an expert’s cognitive judgements in complex and dynamic environments. Candidate methodologies were systematically and critically reviewed in order to identify the most promising methodologies for uncovering expert situational awareness and metacognitive evaluations in pursuit of actionable threat mitigation strategies in high-risk contexts. Research outputs are synthesized into an interview protocol for eliciting and understanding the in-situ actions and decisions of experts in high-risk, complex operating environments. Practical implications: Trainees entering high-risk operating environments can benefit from exposure to expert reflective strategies whilst learning the trade. Typical operator training focuses on technical aspects of threat mitigation but often overlooks reflective self-evaluation. The present study represents an initial step towards determining the feasibility of designing a reflective XAI agent to augment the performance of trainees entering high-risk operations. Outputs of the expert knowledge elicitation protocol documented here shall be used to refine a theoretical framework of expert operator judgement, in order to determine decision support strategies of benefit to domain novices.

In 1990, George Miller outlined a new model for the assessment of clinical competency.1 Miller argued that the traditional assessment of medical students relied too much on testing their knowledge, and not enough on assessing how they would behave in a real-life consultation.1 His model, known as the ‘Miller pyramid’, was the basis for an important move away from the traditional Flexnerian medical education model that was largely dominated by theoretical knowledge-based assessments, towards examinations based on clinical performance. Miller’s pyramid model divides the development of clinical competence into four, hierarchical processes.1 On the lowest level of the pyramid is ‘knowledge’, tested by written exams and traditional multiple-choice questions (MCQs).2 The next level stands for ‘application of knowledge’, assessed by essays, clinical problem-solving exercises and extended MCQs.2 The third tier of the pyramid represents ‘clinical skills competency’, assessed by standardized patient exercises, simulations and clinical exams.2 Finally, on top of the pyramid is ‘clinical performance’, assessed by direct observation in real clinical settings.2 The lower level processes account for the cognitive components of competence and involve classroom-based assessments, while the two higher tiers of the pyramid account for the behavioural components of clinical competence, which involve assessment in simulated and real clinical settings.3 By placing the observable behaviour at the apex of the hierarchy, Miller’s pyramid implies a preference towards the behaviourist tradition, as opposed to cognitive perspectives. Miller’s model suggested that simulated practice could provide a good approximation to how students would behave in the real-world clinical setting, and therefore firmly argued for the introduction of performance-based assessments. In the second half of the 20th century, the ‘performance-as-competence’ paradigm led to an increased use of a new form of assessment in medical training, known as Objective Structured Clinical Examinations (OSCEs). These examinations were designed to test the clinical competence of trainees in a novel way, through the observation of participants across a series of timed stations that could involve history taking, physical examination or patient management, evaluated through standardized checklists, providing a level of objectivity. Today, OSCEs are one of the most widely used assessment methods in medical education. However, their wide adoption to assess clinical competencies does not reflect their inherent limitations. Caution should be particularly exercised when new skills are being added, as OSCEs may not be suitable for the assessment of all clinical skills4,5 and a fundamental problem arises when OSCEs are used for the assessment of cognitive skills, such as diagnostic reasoning. Diagnostic reasoning refers to the cognitive processes involved in diagnosis and management in medical practice. The recent increase in awareness of the importance of this skill has stimulated medical schools to integrate diagnostic reasoning into their curricula.6 In the absence of a more appropriate assessment method, it has often been added to the list of competencies that OSCEs may be used to assess.7,8 However, this ignores the fundamental fact that according to Miller’s pyramid, OSCEs were never intended to assess cognitive skills in the first place. Miller’s pyramid clearly indicates that standardized patient exercises, such as OSCEs are designed to assess observable behaviour, rather than cognitive skills. The problem with using traditional, observation-based assessment for diagnostic reasoning is that it does not allow assessment of the process of diagnostic reasoning, only the distal outcome of this process. It can only assume the reasoning process based on the questions being asked and the diagnosis and management being formulated. However, asking the right questions or stating the right diagnosis does not necessarily mean that the reasoning process itself was correct.9 Without further investigating why a student is asking those particular questions, and how the information they are collecting is being interpreted in the light of their working diagnosis, it may not be possible to differentiate students with differing degrees of diagnostic reasoning investment.9 OSCEs do not provide an opportunity for students to overtly express their reasoning process, the discrepancy between what students think and what they say out loud can easily be misinterpreted, which renders such method unreliable. This is consistent with emerging evidence showing that OSCE performance does not necessarily align with diagnostic reasoning skills.10,11 A quantitative study of sixty-five fourth-year medical students has found that OSCE performance scores do not correlate with diagnostic reasoning or diagnostic accuracy scores.10 This study therefore concluded that traditional OSCE scores do not reflect the students’ diagnostic reasoning ability.10 A recent qualitative study has also found that fourth-year medical students’ diagnostic approach during OSCE-style consultations do not reflect their true diagnostic ability.11 Whilst it is important to acknowledge the inherent limitations of these early studies, such as their cross-sectional nature and single-centre design with small participant numbers, their findings should not be dismissed. They highlight an important discrepancy between OSCE performance and diagnostic reasoning ability, which may be due to the fundamental misalliance of using an observational assessment method to evaluate a covert, complex cognitive skill. Diagnostic reasoning is an essential part of clinical competency, and the theoretical framework for clinical competency assessment needs to take this into account. In order to achieve this, the cognitive elements of the Miller pyramid need to be given more emphasis. While the competencies of ‘knowledge’ and ‘application of knowledge’ on the lower two tiers are essential for assessing medical knowledge in classroom settings, the cognitive element should not stop there. Due to the context dependent nature of diagnostic reasoning, it is important for learners to demonstrate their reasoning process of solving diagnostic problems in a clinical context. Therefore, the upper tiers of Miller’s pyramid need to incorporate ‘sound diagnostic reasoning’ assessed first in simulated, and then in the real-world, clinical setting. Revising Miller’s pyramid by placing greater emphasis on the cognitive elements of competency, could be the first step towards developing an assessment strategy that values the importance of diagnostic reasoning. Considering the importance of sound diagnostic reasoning skills for safe clinical practice, it is essential that medical graduates entering clinical practice are assessed on this skill in order to make sure they have the necessary skills to practice safely in their new role as junior doctors. Therefore, it is important to put in place adequate assessment methods in undergraduate medical education, which focuses on the use of diagnostic reasoning. Based on the arguments discussed here, it is important to consider how existing assessment methods, such as OSCEs could be modified to better suit the covert nature of diagnostic reasoning skills. Combining think-aloud protocols with real or simulated practice may overcome the limitations of current practices. Instructing the students to verbalize their reasoning process pre- and post-consultation may increase their engagement in active diagnostic reasoning during the diagnostic task and thereby facilitate the development of their diagnostic skills. Conflict of Interest The authors declare that they have no conflict of interest.

Declining inflation in many countries over the past few decades at the same time as rising global competition has led to a debate on the importance of globalisation for domestic inflation. This paper explores the implications of global value chain (GVC) integration and market contestability for inflation using a range of industry-level and micro-data sources. We provide evidence that rising participation in GVCs has placed downward pressure on producer price inflation, by increasing the ability of firms to substitute domestic inputs with cheaper foreign equivalents. We investigate the channels, which suggests that increased GVC participation contributed to lower inflation via downward pressures on unit labour costs – by raising productivity and reducing wages – in the importing country, especially when low-wage countries are integrated in supply chains. We then present industry-level evidence to support the conjecture that a higher level of GVC integration dampens producer price inflation by accentuating the impact of global economic slack on domestic inflation. However, we also find an increasing trend in mark-ups, suggestive of rising market power, particularly in services sectors. Thus, looking forward, there is a risk that stalling globalisation since the crisis, coupled with stronger aggregate demand and declining market contestability, could lead to inflationary pressures in the medium term, thereby letting the inflation genie out of the bottle.

Several community gardens have been developed in Edinburgh over the past five years, which reflects renewed interest in “grow your own” projects, and the recognition of the associated environmental and social health benefits they provide. Community gardens have been included in a range of policy documents at national and local levels, acknowledging their contribution to sustainable food systems, health and well-being and environment and biodiversity. This research explores how public policy influences community garden practice and, reflexively, how organisations running community gardens in the third sector are represented in public policy frameworks. A mixed methodology of desk-based research of policy documents, associated reports and academic literature; and informal interviews with community gardens staff and organisers was utilised. It was found that while community gardens are represented in policy, at a national level the framing of community gardens and related food growing projects as “alternativ...

Team design is meticulously specified for assertive community treatment (ACT) teams, yet performance can vary across ACT teams, even those with high fidelity. By developing and validating the Teamwork in Assertive Community Treatment (TACT) scale, investigators examined the role of team processes in ACT performance.The TACT scale measuring ACT teamwork was developed from a conceptual model grounded in organizational research and adapted for the ACT and mental health context. TACT subscales were constructed after exploratory and confirmatory factor analyses. The reliability, discriminant validity, predictive validity, temporal stability, internal consistency, and within-team agreement were established with surveys from approximately 300 members of 26 Minnesota ACT teams who completed the questionnaire three times, at six-month intervals.Nine TACT subscales emerged from the analyses: exploration, exploitation of new and existing knowledge, psychological safety, goal agreement, conflict, constructive controversy, information accessibility, encounter preparedness, and consumer-centered care. These nine subscales demonstrated fit and temporal stability (confirmatory factor analysis), high internal consistency (Cronbach's alpha), and within-team agreement and between-team differences (rwg and intraclass correlations). Correlational analyses of the subscales revealed that they measure related yet distinctive aspects of ACT team processes, and regression analyses demonstrated predictive validity (encounter preparedness is related to staff outcomes).The TACT scale demonstrated high reliability and validity and can be included in research and evaluation of teamwork in ACT and mental health teams.

The purpose of this study was to move beyond the traditional specificity model of autobiographical memory (ABM) and to examine the content of memories with a focus on disorder and schema-relevant content. The sample (N = 82) included 25 patients with major depressive disorder (MDD), 24 with social phobia (SP), and 33 with panic disorder with agoraphobia (PDA) who were referred to a large outpatient clinic for group treatment of depression or anxiety. Participants completed the Autobiographical Memory Test (AMT) and Beck Depression Inventory-II as part of the clinical intake process. Responses to the AMT were coded for disorder-specific content based on diagnostic criteria for each disorder as well as for schema-relevant (sociotropy vs. autonomy) content. A repeated measures multiple analysis of variance demonstrated significant differences in disorder-specific content, with patients in the MDD group reporting more depressotypic ABMs than those in the PDA group but not the SP group. Similarly, in the analysis of schema-relevant content, significant differences were found between MDD and PDA regarding the presence of autonomy-based ABM ratings. Study results provide partial support for the cognitive specificity hypothesis with ABM content. The results are discussed in relation to the cognitive models of depression and anxiety.

Motion is represented by low-level signals, such as size-expansion in vision or loudness changes in the auditory modality. The visual and auditory signals from the same object or event may be integrated and facilitate detection. We explored behavioural and electrophysiological correlates of congruent and incongruent audio–visual depth motion in conditions where auditory level changes, visual expansion, and visual disparity cues were manipulated. In Experiment 1 participants discriminated auditory motion direction whilst viewing looming or receding, 2D or 3D, visual stimuli. Responses were faster and more accurate for congruent than for incongruent audio–visual cues, and the congruency effect (i.e., difference between incongruent and congruent conditions) was larger for visual 3D cues compared to 2D cues. In Experiment 2, event-related potentials (ERPs) were collected during presentation of the 2D and 3D, looming and receding, audio–visual stimuli, while participants detected an infrequent deviant sound. Our main finding was that audio–visual congruity was affected by retinal disparity at an early processing stage (135–160 ms) over occipito-parietal scalp. Topographic analyses suggested that similar brain networks were activated for the 2D and 3D congruity effects, but that cortical responses were stronger in the 3D condition. Differences between congruent and incongruent conditions were observed between 140–200 ms, 220–280 ms, and 350–500 ms after stimulus onset.

Whilst bus lanes are an important tool to ensure bus time reliability their presence can be detrimental to urban traffic. In this paper a Non-dominated Sorting Genetic Algorithm (NSGA-II) has been adopted to study the effect of bus lanes on urban traffic in terms of location and time of operation. Due to the complex nature of this problem traditional search would not be feasible. An artificial arterial route has been modelled from real data to evaluate candidate solutions. The results confirm this methodology for the purpose of studying and identifying bus lane locations and times of operation. Additionally it is shown that bus lanes can exist on an arterial link without exclusively occupying a continuous lane for large periods of time. Furthermore results indicate a use for this methodology over a larger scale and potential near real-time operation.

In 2009, 65 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 236,291 notifications of communicable diseases to the National Notifiable Diseases Surveillance System, an increase of 48% on the number of notifications in 2008. This increase was largely due to cases of influenza A(H1N1) pandemic 2009. In 2009, the most frequently notified diseases were vaccine preventable diseases (101,627 notifications, 43% of total notifications), sexually transmissible infections (73,399 notifications, 31% of total notifications), and gastrointestinal diseases (31,697 notifications, 13% of total notifications). There were 18,861 notifications of bloodborne diseases; 8,232 notifications of vectorborne diseases; 1,919 notifications of other bacterial infections; 552 notifications of zoonoses and 4 notifications of quarantinable diseases.

It is known that Assertive Community Treatment (ACT) is being used to treat people with borderline personality disorder (BPD), a puzzling trend given the lack of empirical support for this practice and the consensus that reserving ACT for a carefully selected population is critical to the sustainability of this costly intervention. Little is known about the contributors to this phenomenon and the ways in which ACT programs have adapted to the influx of patients with BPD. Many ACT programs in the US and Canada have integrated Dialectical Behavioral Therapy into the regular ACT programming, a practice that also lacks rigorous evidence of effectiveness. We provide a framework for policy-makers to decide on the optimal role of ACT in the continuum of care for people with BPD, and offer policy recommendations to address this phenomenon. There is an urgent need to generate the missing evidence and to improve and expand the services available to people with BPD, particularly those who are now being treated on ACT programs.