A virtual surgery in general practice: evaluation of a novel undergraduate virtual patient learning package

Background: A suite of 10 online virtual patients developed using the IVIMEDS ‘Riverside’ authoring tool has been introduced into our undergraduate general practice clerkship. These cases provide a multimedia-rich experience to students. Their interactive nature promotes the development of clinical reasoning skills such as discriminating key clinical features, integrating information from a variety of sources and forming diagnoses and management plans.

Aims: To evaluate the usefulness and usability of a set of online virtual patients in an undergraduate general practice clerkship.
Method: Online questionnaire completed by students after their general practice placement incorporating the System Usability Scale questionnaire.

Results: There was a 57% response rate. Ninety-five per cent of students agreed that the online package was a useful learning tool and ranked virtual patients third out of six learning modalities. Questions and answers and the use of images and videos were all rated highly by students as useful learning methods. The package was perceived to have a high level of usability among respondents.

Conclusion: Feedback from students suggest that this implementation of virtual patients, set in primary care, is user friendly and rated as a valuable adjunct to their learning. The cost of production of such learning resources demands close attention to design.

Pan-STARRS1 DISCOVERY OF TWO ULTRALUMINOUS SUPERNOVAE AT(z) approximate to 0.9

We present the discovery of two ultraluminous supernovae (SNe) at z approximate to 0.9 with the Pan-STARRS1 Medium Deep Survey. These SNe, PS1-10ky and PS1-10awh, are among the most luminous SNe ever discovered, comparable to the unusual transients SN 2005ap and SCP 06F6. Like SN 2005ap and SCP 06F6, they show characteristic high luminosities (M-bol approximate to -22.5 mag), blue spectra with a few broad absorption lines, and no evidence for H or He. We have constructed a full multi-color light curve sensitive to the peak of the spectral energy distribution in the rest-frame ultraviolet, and we have obtained time series spectroscopy for these SNe. Given the similarities between the SNe, we combine their light curves to estimate a total radiated energy over the course of explosion of (0.9-1.4) x 10(51) erg. We find photospheric velocities of 12,000-19,000 km s(-1) with no evidence for deceleration measured across similar to 3 rest-frame weeks around light curve peak, consistent with the expansion of an optically thick massive shell of material. We show that, consistent with findings for other ultraluminous SNe in this class, radioactive decay is not sufficient to power PS1-10ky, and we discuss two plausible origins for these events: the initial spin-down of a newborn magnetar in a core-collapse SN, or SN shock breakout from the dense circumstellar wind surrounding a Wolf-Rayet star.

DISPLAYING THE HETEROGENEITY OF THE SN 2002cx-LIKE SUBCLASS OF TYPE Ia SUPERNOVAE WITH OBSERVATIONS OF THE Pan-STARRS-1 DISCOVERED SN 2009ku

SN 2009ku, discovered by Pan-STARRS-1, is a Type Ia supernova (SN Ia), and a member of the distinct SN 2002cx-like class of SNe Ia. Its light curves are similar to the prototypical SN 2002cx, but are slightly broader and have a later rise to maximum in g. SN 2009ku is brighter (similar to 0.6 mag) than other SN 2002cx-like objects, peaking at M-V = -18.4 mag, which is still significantly fainter than typical SNe Ia. SN 2009ku, which had an ejecta velocity of similar to 2000 km s(-1) at 18 days after maximum brightness, is spectroscopically most similar to SN 2008ha, which also had extremely low-velocity ejecta. However, SN 2008ha had an exceedingly low luminosity, peaking at M-V = -14.2 mag, similar to 4 mag fainter than SN 2009ku. The contrast of high luminosity and low ejecta velocity for SN 2009ku is contrary to an emerging trend seen for the SN 2002cx class. SN 2009ku is a counterexample of a previously held belief that the class was more homogeneous than typical SNe Ia, indicating that the class has a diverse progenitor population and/or complicated explosion physics. As the first example of a member of this class of objects from the new generation of transient surveys, SN 2009ku is an indication of the potential for these surveys to find rare and interesting objects.

On the nature of the progenitors of three Type II-P supernovae: 2004et, 2006my and 2006ov

The pre-explosion observations of the Type II-P supernovae 2006my, 2006ov and 2004et are re-analysed. In the cases of supernovae 2006my and 2006ov we argue that the published candidate progenitors are not coincident with their respective supernova sites in pre-explosion Hubble Space Telescope observations. We therefore derive upper luminosity and mass limits for the unseen progenitors of both these supernovae, assuming they are red supergiants: 2006my (log L/L-circle dot = 4.51; m

Two type Ic supernovae in low-metallicity, dwarf galaxies: diversity of explosions

Aims. The aim of this paper is to discuss the nature of two type Ic supernovae SN 2007bg and SN 2007bi and their host galaxies. Both supernovae were discovered in wide-field, non-targeted surveys and are found to be associated with sub-luminous blue dwarf galaxies identified in SDSS images.

Progenitors of Core-Collapse Supernovae

Knowledge of the progenitors of core-collapse supernovae is a fundamental component in understanding the explosions. The recent progress in finding such stars is reviewed. The minimum initial mass that can produce a supernova (SN) has converged to 8 +/- 1 M-circle dot from direct detections of red supergiant progenitors of II-P SNe and the most massive white dwarf progenitors, although this value is model dependent. It appears that most type Ibc SNe arise from moderate mass interacting binaries. The highly energetic, broad-lined Ic SNe are likely produced by massive, Wolf-Rayet progenitors. There is some evidence to suggest that the majority of massive stars above similar to 20 M-circle dot may collapse quietly to black holes and that the explosions remain undetected. The recent discovery of a class of ultrabright type H SNe and the direct detection of some progenitor stars bearing luminous blue variable characteristics suggest some very massive stars do produce highly energetic explosions. The physical mechanism is under debate, and these SNe pose a challenge to stellar evolutionary theory.

General Practice after the Introduction of the QOF

While the Quality and Outcomes Framework (QOF) is reported to improve performance, its impact on some aspects of organisations need to be explored given the increased reliance on such schemes. Organisational culture can be seen as providing a sense of common values, belief, and norms, which may act as guidelines for behaviour in organisational settings. This research employs a competing value framework depictures different types of culture based on specific focuses and processes. The study is based on interviews with 2 GP practices in the north of England involving 19 participants. Healthcare professionals were aware that there is a dominant value held and shared strongly among members of the organisations-to provide high quality patient-centred services. This study found that while clan culture is still strong in both practices, changes occured in respondents' culture after the implementation of the QOF.

AUDIT OF ANTIBIOTIC USAGE IN A MEDIUM-SIZED GENERAL-HOSPITAL OVER AN 11-YEAR PERIOD - THE IMPACT OF ANTIBIOTIC POLICIES

The objective of the present study was to evaluate trends in antibiotic expenditure over an 11-year period (1982-1992) in a 370-bed district general hospital in Northern Ireland and to examine the impact of two separate antibiotic policies on antibiotic usage. A further objective was to examine the attitudes of prescribers to the second policy. Drug utilization review was used to collect information on antibiotic expenditure and usage before and after introduction of separate antibiotic policies in 1985 (not intensively monitored) and 1989 (intensively monitored). A mail questionnaire was used to determine the attitudes of prescribers. The first policy (1985) showed no benefits with regard to the number of antibiotic entities stocked (45 before, 45 after), number of dosage units issued (9.35 increase) or expenditure (33.35 increase). The 1989 policy led to significant reductions in the number of antibiotic entities stocked (28.9%), number of antibiotics issued (11.9%) and expenditure (6.1%). Expenditure began to spiral upwards when active monitoring of the second policy was suspended. The majority of prescribers (87.2%) who responded to the questionnaire (56.5% response rate) felt that the 1989 policy made a positive contribution to antibiotic usage in the hospital.