Evaluation of extended training for general practice in Northern Ireland: qualitative study.

Objective To evaluate participants' perceptions of the impact on them of an additional six months' training beyond the standard 12 month general practice vocational training scheme. Design Qualitative study using focus groups. Setting General practice vocational training in Northern Ireland. Participants 13 general practitioner registrars, six of whom participated in the additional six months' training, and four trainers involved in the additional six months' training. Main outcome measures: Participants' views about their experiences in 18 month and 12 month courses. Results Participants reported that the 12 month course was generally positive but was too pressurised and focused on examinations, and also that it had a negative impact on self care. The nature of the learning and assessment was reported to have left participants feeling averse to further continuing education and lacking in confidence. In contrast, the extended six month component was reported to have restimulated learning by focusing more on patient care and promoting self directed learning. It developed confidence, promoted teamwork, and gave experience of two practice contexts, and was reported as valuable by both ex-registrars and trainers. However, both the 12 and 18 month courses left participants feeling underprepared for practice management and self care. Conclusions 12 months' training in general practice does not provide doctors with the necessary competencies and confidence to enter independent practice. The extended period was reported to promote greater professional development, critical evaluation skills, and orientation to lifelong learning but does not fill all the gaps.

In vitro phototoxicity of 5-aminolevulinic acid and its methyl ester and the influence of barrier properties on their release from a bioadhesive patch.

opical administration of excess exogenous 5-aminolevulinic acid (ALA) leads to selective accumulation of the potent photosensitiser protoporphyrin IX (PpIX) in neoplastic cells, which can then be destroyed by irradiation with visible light. Due to its hydrophilicity, ALA penetrates deep lesions, such as nodular basal cell carcinomas (BCCs) poorly. As a result, more lipophilic esters of ALA have been employed to improve tissue penetration. In this study, the in vitro release of ALA and M-ALA from proprietary creams and novel patch-based systems across normal stratum corneum and a model membrane designed to mimic the abnormal stratum corneum overlying neoplastic skin lesions were investigated. Receiver compartment drug concentrations were compared with the concentrations of each drug producing high levels of PpIX production and subsequent light-induced kill in a model neoplastic cell line (LOX). LOX cells were found to be quite resistant to ALA- and M-ALA-induced phototoxicity. However, drug concentrations achieved in receiver compartments were comparable to those required to induce high levels of cell death upon irradiation in cell lines reported in the literature. Patches released significantly less drug across normal stratum corneum and significantly more across the model membrane. This is of major significance since the selectivity of PDT for neoplastic lesions will be further enhanced by the delivery system. ALA/M-ALA will only be delivered in significant amounts to the abnormal tissue. PpIX will only then accumulate in the neoplastic cells and the normal surrounding tissue will be unharmed upon irradiation.

Complex weathering in drylands: implications of 'stress' history for rock debris breakdown and sediment release

Weathering studies have often sought to explain features in terms of a prevailing set of environmental conditions. However, it is clear that in most present-day hot desert regions, the surface rock debris has been exposed to a range of weathering environments and processes. These different weathering conditions can arise in two ways, either from the effects of long-term climate change acting on debris that remains relatively static within the landscape or through the spatial relocation of debris from high to low altitude. Consequently, each fragment of rock may contain a unique weathering-related legacy of damage and alteration — a legacy that may greatly influence its response to present-day weathering activity. Experiments are described in which blocks of limestone, sandstone, granite and basalt are given ‘stress histories’ by subjecting them to varying numbers of heating and freezing cycles as a form of pre-treatment. These imposed stress histories act as proxies for a weathering history. Some blocks were used in a laboratory salt weathering simulation study while others underwent a 2 year field exposure trial at high, mid and low altitude sites in Death Valley, California. Weight loss and ultrasonic pulse velocity measurements suggest that blocks with stress histories deteriorate more rapidly than unstressed samples of the same rock type exposed to the same environmental conditions. Laboratory data also indicate that the result of imposing a known ‘weathering history’ on samples by pre-stressing them is an increase in the amount of fine sediment released during salt weathering over a given period of time in comparison to unstressed samples.

Software Release Planning: An Evolutionary and Iterative Approach

Abstract To achieve higher flexibility and to better satisfy actual customer requirements, there is an increasing tendency to develop and deliver software in an incremental fashion. In adopting this process, requirements are delivered in releases and so a decision has to be made on which requirements should be delivered in which release. Three main considerations that need to be taken account of are the technical precedences inherent in the requirements, the typically conflicting priorities as determined by the representative stakeholders, as well as the balance between required and available effort. The technical precedence constraints relate to situations where one requirement cannot be implemented until another is completed or where one requirement is implemented in the same increment as another one. Stakeholder preferences may be based on the perceived value or urgency of delivered requirements to the different stakeholders involved. The technical priorities and individual stakeholder priorities may be in conflict and difficult to reconcile. This paper provides (i) a method for optimally allocating requirements to increments; (ii) a means of assessing and optimizing the degree to which the ordering conflicts with stakeholder priorities within technical precedence constraints; (iii) a means of balancing required and available resources for all increments; and (iv) an overall method called EVOLVE aimed at the continuous planning of incremental software development. The optimization method used is iterative and essentially based on a genetic algorithm. A set of the most promising candidate solutions is generated to support the final decision. The paper evaluates the proposed approach using a sample project.

Analysis of Extended Partial Least Squares for Monitoring Large-Scale Processes

This paper theoretically analysis the recently proposed "Extended Partial Least Squares" (EPLS) algorithm. After pointing out some conceptual deficiencies, a revised algorithm is introduced that covers the middle ground between Partial Least Squares and Principal Component Analysis. It maximises a covariance criterion between a cause and an effect variable set (partial least squares) and allows a complete reconstruction of the recorded data (principal component analysis). The new and conceptually simpler EPLS algorithm has successfully been applied in detecting and diagnosing various fault conditions, where the original EPLS algorithm did only offer fault detection.