Patient safety and communication: A new assessment for doctors trained in countries where language differs from that of the host country: Results of a pilot using a domain-based assessment

Objective

Global migration of healthcare workers places responsibility on employers to comply with legal employment rights whilst ensuring patient safety remains the central goal. We describe the pilot of a communication assessment designed for doctors who trained and communicated with patients and colleagues in a different language from that of the host country. It is unique in assessing clinical communication without assessing knowledge.

A 14-station OSCE was developed using a domain-based marking scheme, covering professional communication and English language skills (speaking, listening, reading and writing) in routine, acute and emotionally challenging contexts, with patients, carers and healthcare teams. Candidates (n = 43), non-UK trained volunteers applying to the UK Foundation Programme, were provided with relevant station information prior to the exam.

The criteria for passing the test included achieving the pass score and passing 10 or more of the 14 stations. Of the 43 candidates, nine failed on the station criteria. Two failed the pass score and also the station criteria. The Cronbach's alpha coefficient was 0.866.

This pilot tested ‘proof of concept’ of a new domain-based communication assessment for non-UK trained doctors.

The test would enable employers and regulators to verify communication competence and safety in clinical contexts, independent of clinical knowledge, for doctors who trained in a language different from that of the host country.

Class Responsibility Assignment (CRA) for Use Case Specification to Sequence Diagrams (UC2SD)

Identifying responsibility for classes in object oriented software design phase is a crucial task. This paper proposes an approach for producing high quality and robust behavioural diagrams (e.g. Sequence Diagrams) through Class Responsibility Assignment (CRA). GRASP or General Responsibility Assignment Software Pattern (or Principle) was used to direct the CRA process when deriving behavioural diagrams. A set of tools to support CRA was developed to provide designers and developers with a cognitive toolkit that can be used when analysing and designing object-oriented software. The tool developed is called Use Case Specification to Sequence Diagrams (UC2SD). UC2SD uses a new approach for developing Unified Modelling Language (UML) software designs from Natural Language, making use of a meta-domain oriented ontology, well established software design principles and established Natural Language Processing (NLP) tools. UC2SD generates a well-formed UML sequence diagrams as output.

A diode for ferroelectric domain-wall motion

For over a decade, controlling domain wall injection, motion and annihilation along nanowires has been the preserve of the nanomagnetics research community. Revolutionary technologies have resulted, like race-track memory and domain wall logic. Until recently, equivalent research in analogous ferroic materials did not seem important. However, with the discovery of sheet conduction, the control of domain walls in ferroelectrics has become vital for the future of what has been termed “domain wall electronics”. Here we report the creation of a ferroelectric domain wall diode, which allows a single direction of motion for all domain walls, irrespective of their polarity, under a series of alternating electric field pulses. The diode’s saw-tooth morphology is central to its function. Domain walls can move readily in the direction in which thickness increases gradually, but are prevented from moving in the other direction by the sudden thickness increase at the saw-tooth edge.

FRENKEL-KONTOROVA DOMAIN-WALL PHASE-TRANSITIONS IN AN ADSORBED LAYER - POTASSIUM ON CO(10(1)OVER-BAR-0)

As the potassium fractional coverage of a cobalt {1010BAR} surface is increased over the range 0.2 to 0.6 monolayer the adlayer passes through a series of phase transitions. A commensurate phase is formed at exactly 0.5 monolayer, and corresponds to adatoms bonded in high-symmetry hollow sites on the unreconstructed cobalt surface, with an effective adatom radius lying between the ionic and covalent radii of potassium. A detailed structural study shows that the structural transitions can be characterised within a one-dimensional Frenkel-Kontorova model, with small lateral displacements of adatoms away from hollow sites in the low and high coverage phases. The low coverage phases progress from a distributed vacancy structure to a low density domain-wall structure; while the high coverage phase formed above half a monolayer is a high density asymmetric domain-wall structure.

A mixed cost-function adaptive algorithm for ADSL time-domain equalization

We propose a mixed cost-function adaptive initialization algorithm for the time domain equalizer in a discrete multitone (DMT)-based asymmetric digital subscriber line. Using our approach, a higher convergence rate than that of the commonly used least-mean square algorithm is obtained, whilst attaining bit rates close to the optimum maximum shortening SNR and the upper bound SNR. Furthermore, our proposed method outperforms the minimum mean-squared error design for a range of time domain equalizer (TEQ) filter lengths. The improved performance outweighs the small increase in computational complexity required. A block variant of our proposed algorithm is also presented to overcome the increased latency imposed on the feedback path of the adaptive system.

Accumulation of the PX domain mutant Frank-ter Haar syndrome protein Tks4 in aggresomes

BACKGROUND: Cells deploy quality control mechanisms to remove damaged or misfolded proteins. Recently, we have reported that a mutation (R43W) in the Frank-ter Haar syndrome protein Tks4 resulted in aberrant intracellular localization.

RESULTS: Here we demonstrate that the accumulation of Tks4(R43W) depends on the intact microtubule network. Detergent-insoluble Tks4 mutant colocalizes with the centrosome and its aggregate is encaged by the intermediate filament protein vimentin. Both the microtubule inhibitor nocodazole and the histone deacetylase inhibitor Trichostatin A inhibit markedly the aggresome formation in cells expressing Tks4(R43W). Finally, pretreatment of cells with the proteasome inhibitor MG132 markedly increases the level of aggresomes formed by Tks4(R43W). Furthermore, two additional mutant Tks4 proteins (Tks4(1-48) or Tks4(1-341)) have been investigated. Whereas the shorter Tks4 mutant, Tks4(1-48), shows no expression at all, the longer Tks4 truncation mutant accumulates in the nuclei of the cells.

CONCLUSIONS: Our results suggest that misfolded Frank-ter Haar syndrome protein Tks4(R43W) is transported via the microtubule system to the aggresomes. Lack of expression of Tks4(1-48) or aberrant intracellular expressions of Tks4(R43W) and Tks4(1-341) strongly suggest that these mutations result in dysfunctional proteins which are not capable of operating properly, leading to the development of FTHS.

Inactivating mutations in an SH2 domain-encoding gene in X-linked lymphoproliferative syndrome

X-linked lymphoproliferative syndrome (XLP) is an inherited immunodeficiency characterized by increased susceptibility to Epstein-Barr virus (EBV). In affected males, primary EBV infection leads to the uncontrolled proliferation of virus-containing B cells and reactive cytotoxic T cells, often culminating in the development of high-grade lymphoma. The XLP gene has been mapped to chromosome band Xq25 through linkage analysis and the discovery of patients harboring large constitutional genomic deletions. We describe here the presence of small deletions and intragenic mutations that specifically disrupt a gene named DSHP in 6 of 10 unrelated patients with XLP. This gene encodes a predicted protein of 128 amino acids composing a single SH2 domain with extensive homology to the SH2 domain of SHIP, an inositol polyphosphate 5-phosphatase that functions as a negative regulator of lymphocyte activation. DSHP is expressed in transformed T cell lines and is induced following in vitro activation of peripheral blood T lymphocytes. Expression of DSHP is restricted in vivo to lymphoid tissues, and RNA in situ hybridization demonstrates DSHP expression in activated T and B cell regions of reactive lymph nodes and in both T and B cell neoplasms. These observations confirm the identity of DSHP as the gene responsible for XLP, and suggest a role in the regulation of lymphocyte activation and proliferation. Induction of DSHP may sustain the immune response by interfering with SHIP-mediated inhibition of lymphocyte activation, while its inactivation in XLP patients results in a selective immunodeficiency to EBV.

Dengue Envelope Domain III-Peptide Binding Analysis via Tryptophan Fluorescence Quenching Assay

In the efforts to find an anti-viral treatment for dengue, a simple tryptophan fluorescence-screening assay aimed at identifying dengue domain III envelope (EIII) protein inhibitors was developed. Residue Trp391 of EIII was used as an intrinsic probe to monitor the change in fluorescence of the tryptophan residue upon binding to a peptide. The analysis was based on the electron excitation at 280 nm and fluorescence emission at 300–400 nm of EIII, followed by quenching of fluorescence in the presence of potential peptidic inhibitors coded DS36wt, DS36opt, DN58wt and DN58opt. The present study found that the fluorescence of the recombinant EIII was quenched following the binding of DS36opt, DN58wt and DN58opt ina concentration-dependent manner. Since the λmax for emission remained unchanged, the effect was not dueto a change in the environment of the tryptophan side chain. In contrast, a minimal fluorescence-quenching effect of DS36wt at 20 and 40 µM suggested that the DS36wt does not have any binding ability to EIII. This was supported by a simple native-page gel retardation assay that showed a band shift of EIII domain whenincubated with DS36opt, DN58wt and DN58opt but not with DS36wt. We thus developed a low-cost and convenientspectrophotometric binding assay for the analysis of EIII–peptide interactions in a drug screening application.