Would changing the selection process for GP trainees stem the workforce crisis? A cohort study using multiple-imputation and simulation

BACKGROUND: There is currently a shortage of qualified GPs in the UK and not all of the training posts available each year are filled. Changing the way in which GP trainees are selected could help increase the training post fill rate and the number of new entrants to the GP Register. The aim of this study was to model the impact of changing the selection process for GP training on the number of trainees obtaining GP Registration, either with or without extensions. METHOD: This was a cohort study using UK applications for GP training in 2011-14. Application data were linked using GMC numbers to training outcome data where available, and imputed using multiple imputation where missing. The number of trainees appointed and GP Registrations within three and five years' full-time-equivalent were estimated for four different selection processes. RESULTS: The cut scores used in the actual 2015 selection process makes it impossible to fill all training posts. Random selection is the worst option, but the difference between this and other processes modelled falls as more trainees are selected. There are large marginal effects on outcomes: those with the highest selection scores are more likely to obtain GP Registration than those with the lowest scores. CONCLUSIONS: Changing the selection process alone would have a small impact on the number of GP Registrations; reducing/removing cut scores would have a much larger impact. This would also increase the number of trainees requiring extensions and being released from training which would have adverse consequences for the profession

Which doctors and with what problems contact a specialist service for doctors? A cross sectional investigation

Background: In the United Kingdom, specialist treatment and intervention services for doctors are underdeveloped. The MedNet programme, created in 1997 and funded by the London Deanery, aims to fill this gap by providing a self-referral, face-to-face, psychotherapeutic assessment service for doctors in London and South-East England. MedNet was designed to be a low-threshold service, targeting doctors without formal psychiatric problems. The aim of this study was to delineate the characteristics of doctors utilising the service, to describe their psychological morbidity, and to determine if early intervention is achieved. Methods: A cross-sectional study including all consecutive self-referred doctors (n = 121, 50% male) presenting in 2002–2004 was conducted. Measures included standardised and bespoke questionnaires both self-report and clinician completed. The multi-dimensional evaluation included: demographics, CORE (CORE-OM, CORE-Workplace and CORE-A) an instrument designed to evaluate the psychological difficulties of patients referred to outpatient services, Brief Symptom Inventory to quantify caseness and formal psychiatric illness, and Maslach Burnout Inventory. Results: The most prevalent presenting problems included depression, anxiety, interpersonal, self-esteem and work-related issues. However, only 9% of the cohort were identified as severely distressed psychiatrically using this measure. In approximately 50% of the sample, problems first presented in the preceding year. About 25% were on sick leave at the time of consultation, while 50% took little or no leave in the prior 12 months. A total of 42% were considered to be at some risk of suicide, with more than 25% considered to have a moderate to severe risk. There were no significant gender differences in type of morbidity, severity or days off sick. Conclusion: Doctors displayed high levels of distress as reflected in the significant proportion of those who were at some risk of suicide; however, low rates of severe psychiatric illness were detected. These findings suggest that MedNet clients represent both ends of the spectrum of severity, enabling early clinical engagement for a significant proportion of cases that is of importance both in terms of personal health and protecting patient care, and providing a timely intervention for those who are at risk, a group for whom rapid intervention services are in need and an area that requires further investigation in the UK

Investigating Dementia via a multicompartmental poroelastic model of parenchymal tissue

In this paper, a workflow within the VPH-DARE@IT Clinical Research Platform is presented. This is used to model the biomechanical behaviour of perfused brain tissue. This workflow features a 3D multicompartmental poroelastic framework, patient-specific brain anatomy representations and continuous waveforms of internal carotid and vertebral arteries, which are used as a means of personalizing the boundary conditions that feed the arterial compartment of the in-house poroelastic solver. Results are shown comparing CSF/ISF clearance and accumulation in two males of similar age, both are non-smokers, however one is more active and is diagnosed with MCI and experiences less sleep

Perspectives on the Trypanosoma cruzi-host cell receptor interaction

Chagas disease is caused by the parasite Trypanosoma cruzi. The critical initial event is the interaction of the trypomastigote form of the parasite with host receptors. This review highlights recent observations concerning these interactions. Some of the key receptors considered are those for thromboxane, bradykinin, and for the nerve growth factor TrKA. Other important receptors such as galectin-3, thrombospondin, and laminin are also discussed. Investigation into the molecular biology and cell biology of host receptors for T. cruzi may provide novel therapeutic targets

Working with the cracks in the rigging in researching early childhood professional development

This paper seeks to explore the development of the relationship between a group of early childhood academics from the same university and practitioners from a particular early years setting in the North of England into an innovative professional development and research project. The paper uses Foucauldian notions of heterotopia to theorise an approach to professional development and research concerned with examining the discourses and practices associated with provision for two-year-old children. In place of a transmission model of professional development and scientific preoccupations with research purity, we explore what is offered by an alternative approach that offered a broader engagement with ideas, feelings and the body and the layering of research complexity. We consider what emerges when the practitioners take the learning from the project back into their own settings and conclude by considering the possibilities and complexities of academics and practitioners working together to research and represent what emerged from the project

Dynamic biospeckle analysis, a new tool for the fast screening of plant nematicide selectivity

Background: Plant feeding, free-living nematodes cause extensive damage to plant roots by direct feeding and, in the case of some trichodorid and longidorid species, through the transmission of viruses. Developing more environmentally friendly, target-specific nematicides is currently impeded by slow and laborious methods of toxicity testing. Here, we developed a bioactivity assay based on the dynamics of light 'speckle' generated by living cells and we demonstrate its application by assessing chemicals' toxicity to different nematode trophic groups.Results: Free-living nematode populations extracted from soil were exposed to methanol and phenyl isothiocyanate (PEITC). Biospeckle analysis revealed differing behavioural responses as a function of nematode feeding groups. Trichodorus nematodes were less sensitive than were bacterial feeding nematodes or non-trichodorid plant feeding nematodes. Following 24 h of exposure to PEITC, bioactivity significantly decreased for plant and bacterial feeders but not for Trichodorus nematodes. Decreases in movement for plant and bacterial feeders in the presence of PEITC also led to measurable changes to the morphology of biospeckle patterns.Conclusions: Biospeckle analysis can be used to accelerate the screening of nematode bioactivity, thereby providing a fast way of testing the specificity of potential nematicidal compounds. With nematodes' distinctive movement and activity levels being visible in the biospeckle pattern, the technique has potential to screen the behavioural responses of diverse trophic nematode communities. The method discriminates both behavioural responses, morphological traits and activity levels and hence could be used to assess the specificity of nematicidal compounds.</p

First narrow-band search for continuous gravitational waves from known pulsars in advanced detector data

Spinning neutron stars asymmetric with respect to their rotation axis are potential sources of continuous gravitational waves for ground-based interferometric detectors. In the case of known pulsars a fully coherent search, based on matched filtering, which uses the position and rotational parameters obtained from electromagnetic observations, can be carried out. Matched filtering maximizes the signalto- noise (SNR) ratio, but a large sensitivity loss is expected in case of even a very small mismatch between the assumed and the true signal parameters. For this reason, narrow-band analysis methods have been developed, allowing a fully coherent search for gravitational waves from known pulsars over a fraction of a hertz and several spin-down values. In this paper we describe a narrow-band search of 11 pulsars using data from Advanced LIGO’s first observing run. Although we have found several initial outliers, further studies show no significant evidence for the presence of a gravitational wave signal. Finally, we have placed upper limits on the signal strain amplitude lower than the spin-down limit for 5 of the 11 targets over the bands searched; in the case of J1813-1749 the spin-down limit has been beaten for the first time. For an additional 3 targets, the median upper limit across the search bands is below the spin-down limit. This is the most sensitive narrow-band search for continuous gravitational waves carried out so far