Creating an integrated payment system: the evolution of Fedwire

Adapted from remarks given before the Seminar on Payment Systems in the European Union in Frankfurt, Germany, on February 27, 1997.Fedwire ; Electronic funds transfers ; Federal Reserve System

Being the ‘med reg’: an exploration of junior doctors’ perceptions of the medical registrar role

The role of the medical registrar is a challenging one and is acknowledged as being a disincentive to a career in medicine for some junior doctors. We set out to build a broader understanding of the role through exploration of Foundation Doctors’ and Core Medical Trainees’ perceptions of the role. Data, gathered from focus groups, were analysed using a framework approach. Six key themes were identified, which were grouped under the headings ‘perceptions of the medical registrar role’ and ‘transition into the role’. Our work builds on existing literature to inform a deeper understanding of how junior doctors perceive the medical registrar role. In light of our findings we offer suggestions on possible training initiatives to tackle the issues identified. We also highlight positive perceptions of the role and emphasise the key ambassadorial role that current medical registrars have in relation to attracting tomorrows’ medical registrars to the specialty

Why geriatric medicine? A survey of UK specialist trainees in geriatric medicine

Background: There is global concern that there are insufficient numbers of geriatricians to meet the needs of the ageing population. A 2005 survey described factors that influenced why UK geriatricians had chosen to specialise in the field - in the decade since, UK postgraduate training has undergone a fundamental restructure. Objective: To explore whether the reasons for choosing a career in geriatric medicine in the UK had changed over time, with the goal of using this knowledge to inform recruitment and training initiatives. Design: An online survey was sent to all UK higher medical trainees in geriatric medicine. Methods: Survey questions that produced categorical data were analysed with simple descriptive statistics. For the survey questions that produced free-text responses, an inductive, iterative approach to analysis, in keeping with the principles of framework analysis, was employed. Results: 269 responses were received out of 641 eligible respondents. Compared with the previous survey, a substantially larger number of respondents regarded geriatric medicine to be their first-choice specialty and a smaller number regretted their career decision. A greater number chose geriatric medicine early in their medical careers. Commitments to the general medical rota and the burden of service provision were considered important downsides to the specialty. Conclusions: There are reasons to be optimistic about recruitment to geriatric medicine. Future attempts to drive up recruitment might legitimately focus on the role of the medical registrar and perceptions that geriatricians shoulder a disproportionate burden of service commitments and obligations to the acute medical take

The Effect of Cone Opsin Mutations on Retinal Structure and the Integrity of the Photoreceptor Mosaic

Purpose. To evaluate retinal structure and photoreceptor mosaic integrity in subjects with OPN1LW and OPN1MW mutations. Methods. Eleven subjects were recruited, eight of whom have been previously described. Cone and rod density was measured using images of the photoreceptor mosaic obtained from an adaptive optics scanning light ophthalmoscope (AOSLO). Total retinal thickness, inner retinal thickness, and outer nuclear layer plus Henle fiber layer (ONL+HFL) thickness were measured using cross-sectional spectral-domain optical coherence tomography (SD-OCT) images. Molecular genetic analyses were performed to characterize the OPN1LW/OPN1MW gene array. Results. While disruptions in retinal lamination and cone mosaic structure were observed in all subjects, genotype-specific differences were also observed. For example, subjects with “L/M interchange” mutations resulting from intermixing of ancestral OPN1LW and OPN1MW genes had significant residual cone structure in the parafovea (∼25% of normal), despite widespread retinal disruption that included a large foveal lesion and thinning of the parafoveal inner retina. These subjects also reported a later-onset, progressive loss of visual function. In contrast, subjects with the C203R missense mutation presented with congenital blue cone monochromacy, with retinal lamination defects being restricted to the ONL+HFL and the degree of residual cone structure (8% of normal) being consistent with that expected for the S-cone submosaic. Conclusions. The photoreceptor phenotype associated with OPN1LW and OPN1MW mutations is highly variable. These findings have implications for the potential restoration of visual function in subjects with opsin mutations. Our study highlights the importance of high-resolution phenotyping to characterize cellular structure in inherited retinal disease; such information will be critical for selecting patients most likely to respond to therapeutic intervention and for establishing a baseline for evaluating treatment efficacy

Making Wakefield Warranted: The Hierarchy of Healing Harm and Discerning Dysfunction

The definition of medical ‘disorder’ is a matter of longstanding debate. A leading account is Jerome Wakefield’s ‘harmful dysfunction’ analysis, a hybrid model which merges normative and naturalist elements to propose disorder exists in cases of concurrent harm (value-defined) and dysfunction (defined evolutionarily). Despite significant impact in academia, this has so far failed to affect mainstream medical treatment or discourse, with a major criticism being that this definition doesn’t correctly capture all conditions of medical relevance or actual medical ideals. This paper provides a supplementary structural nuance to better reflect how medical treatment and terminology incorporate naturalistic facts. I argue that Wakefield is right in utilising a hybrid model incorporating naturalism and normativity. However, in understanding how medicine is directed, making the normative and naturalistic equally necessary is problematic, because the imperatives of naturalism and normativity directly impede each other; norms seek to help those who need help, naturalism concentrates on objective facts, but neither can be fulfilled as a coherent goal of medical treatment when combined as equally necessary. Instead, I propose a hierarchical harmful dysfunction model better reflects current medical ideals, where normative values are necessary and sufficient conditions to prescribe treatment, whilst naturalistic knowledge plays a role informing those normative values. This accounts for the edge cases and practise of medicine not fully captured in Wakefield’s account of ‘disorder’.</p

Spatial Patterns and Sequential Sampling Plans for Estimating Densities of Stink Bugs (Hemiptera: Pentatomidae) in Soybean in the North Central Region of the United States

Stink bugs are an emerging threat to soybean (Fabales: Fabaceae) in the North Central Region of the United States. Consequently, region-specific scouting recommendations for stink bugs are needed. The aim of this study was to characterize the spatial pattern and to develop sampling plans to estimate stink bug population density in soybean fields. In 2016 and 2017, 125 fields distributed across nine states were sampled using sweep nets. Regression analyses were used to determine the effects of stink bug species [Chinavia hilaris (Say) (Hemiptera: Pentatomidae) and Euschistus spp. (Hemiptera: Pentatomidae)], life stages (nymphs and adults), and field locations (edge and interior) on spatial pattern as represented by variance–mean relationships. Results showed that stink bugs were aggregated. Sequential sampling plans were developed for each combination of species, life stage, and location and for all the data combined. Results for required sample size showed that an average of 40–42 sample units (sets of 25 sweeps) would be necessary to achieve a precision of 0.25 for stink bug densities commonly encountered across the region. However, based on the observed geographic gradient of stink bug densities, more practical sample sizes (5–10 sample units) may be sufficient in states in the southeastern part of the region, whereas impractical sample sizes (\u3e100 sample units) may be required in the northwestern part of the region. Our findings provide research-based sampling recommendations for estimating densities of these emerging pests in soybean