How standardised patients award global scores in OSCEs: a qualitative study

Standardized patients (SPs) are often asked to award global scores on the humanistic aspects of a candidate’s performance in an OSCE. However, little is known about the process by which SPs arrive at their mark.
Five focus groups of SPs, using a convenience sample, were used to collect data until saturation. Thematic analysis was carried out independently by three researchers using a grounded theory approach.

Four major themes contributed to their decision-making process: environment, relationships within the exam, preparedness for the task and expectations of the student’s performance. Environmental factors included the station itself, the rating scale and examiner fatigue. Relationship factors included first impressions, the sense of purpose derived from examining and a tendency to mirror the examiner’s reaction. Factors relating to preparedness for task involved experience as an SP and technical aspects, such as the need for calibration. Lastly, expectations of performance were related to preconceptions about what makes a ‘good’ student, including their level of studies, appearance and technical performance.

In assessing students, SPs drew on their wider attitudes and experiences. SPs did not limit their assessment to humanistic traits but often included technical performance. Thus, SPs to some extent assessed a similar construct to examiners and this may help to explain the increased reliability associated with using SP scores. SP global scores are a useful adjunct but the process by which SPs award marks is complex and provides a challenge for training and standardisation.

Integration Of Strength and Process Modelling of Friction-Stir-Welded Fuselage Panels

In order to reduce potential uncertainties and conservatism in welded panel analysis procedures, understanding of the relationships between welding process parameters and static strength is required. The aim of this study is to determine and characterize the key process induced properties of advanced welding assembly methods on stiffened panel local buckling and collapse performance. To this end, an in-depth experimental and computational study of the static strength of a friction stir welded fuselage skin-stiffener panel subjected to compression loading has been undertaken. Four welding process effects, viz. the weld joint width, the width of the weld Heat Affected Zone, the strength of material within the weld Heat Affected Zone and the magnitude of welding induced residual stress, are investigated. A fractional factorial experiment design method (Taguchi) has been applied to identify the relative importance of each welding process effect and investigate effect interactions on both local skin buckling and crippling collapse performance. For the identified dominant welding process effects, parametric studies have been undertaken to identify critical welding process effect magnitudes and boundaries. The studies have shown that local skin buckling is principally influenced by the magnitude of welding induced residual stress and that the strength of material in the Heat Affected Zone and the magnitude of the welding induced residual stress have the greatest influence on crippling collapse behavior.


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Parasite mediated predation between native and invasive amphipods.

Parasites can structure biological communities directly through population regulation and indirectly by processes such as apparent competition. However, the role of parasites in the process of biological invasion is less well understood and mechanisms of parasite mediation of predation among hosts are unclear. Mutual predation between native and invading species is an important factor in determining the outcome of invasions in freshwater amphipod communities. Here, we show that parasites mediate mutual intraguild predation among native and invading species and may thereby facilitate the invasion process. We find that the native amphipod Gammarus duebeni celticus is host to a microsporidian parasite, Pleistophora sp. (new species), with a frequency of infection of 0-90%. However, the parasite does not infect three invading species, G. tigrinus, G. pulex and Crangonyx pseudogracilis. In field and laboratory manipulations, we show that the parasite exhibits cryptic virulence: the parasite does not affect host fitness in single-species populations, but virulence becomes apparent when the native and invading species interact. That is, infection has no direct effect on G. d. celticus survivorship, size or fecundity; however, in mixed-species experiments, parasitized natives show a reduced capacity to prey on the smaller invading species and are more likely to be preyed upon by the largest invading species. Thus, by altering dominance relationships and hierarchies of mutual predation, parasitism strongly influences, and has the potential to change, the outcome of biological invasions.

The Characterization of Friction Stir Welding Process Effects on Stiffened Panel Buckling Performance

The introduction of advanced welding methods as an alternative joining process to riveting in the manufacture of primary aircraft structure has the potential to realize reductions in both manufacturing costs and structural weight. However, welding processes can introduce undesirable residual stresses and distortions in the final fabricated components, as well as localized loss of mechanical properties at the weld joints. The aim of this research is to determine and characterize the key process effects of advanced welding assembly methods on stiffened panel static strength performance. This in-depth understanding of the relationships between welding process effects and buckling and collapse strength is required to achieve manufacturing cost reductions without introducing structural analysis uncertainties and hence conservative over designed welded panels. This current work is focused at the sub-component level and examines the static strength of friction stir welded multi stiffener panels. The undertaken experimental and computational studies have demonstrated that local skin buckling is predominantly influenced by the magnitude of welding induced residual stresses and associated geometric distortions, whereas panel collapse behavior is sensitive to the lateral width of the physically joined skin and stiffener flange material, the strength of material in the Heat Affected Zone as well as the magnitude of the welding induced residual stresses. Copyright © 2006 by the American Institute of Aeronautics and Astronautics, Inc. All rights reserved.


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Beyond the shadow space: architecture as a professional and creative process; during and post-conflict.

Introduction

Much has been written about the impact of conflict on the physical nature of cities; most obviously perhaps the damage, destruction, defensive construction and spatial reconfigurations that evolve in times of conflict. Set within the context of Belfast, Northern Ireland, this paper will focus on three areas. First, a closer reading of the long-term physical impact of conflict, in particular, the spatial forms and practices that persist conceptually and culturally, and/or resist re-conceptualisation. Secondly, the effect of conflict on the nature of architectural practice itself, considering whether issues such as appointment and procurement impacted on architectural expectation and the context of operation. Thirdly, the effect of conflict on people, in particular in relation to creativity and hence the psyche of practice itself. This section will also identify the conditions that undermine or support design quality and creativity not only within times of conflict but also as society evolves out of the shadow space. 1
Twelve years on from the Peace Agreement,2 it may seem remarkable from an external perspective that Northern Ireland still needs to be reflecting on its troubled past. But the immediate post-conflict phase offered the communities of Northern Ireland place and time to experience ‘normal life’, begin to reconcile themselves to the hurt they experienced and start to reconfigure their relationships to one another. Indeed, it has often been expressed that probing the issues too much, at too early a phase, might in fact ‘Open old wounds without resolving anything’ and/or ‘Destabilise the already fragile political system.’3 This tendency not to deliberate or be too probing is therefore understandable and might be the reason why, for example, Northern Ireland's first Architecture and Built Environment policy, published in June, 2006, contains only one routine reference to ‘the Troubles’.

Clearly, however, there is a time in the development of a healthy, functioning society, when in order effectively to plan its future, it must also carry out a closer reading and deeper understanding of its past. As Maya Angelou puts it, ‘History, despite its wrenching pain/ Cannot be unlived, and if faced/ With courage, need not be lived again.’4

Increasingly, those within the creative arts sector and the built environment professions are showing interest in carrying out that closer reading, teasing out issues around conflict. This was led in part by the recent publication of the Troubles Archive by the Arts Council of Northern Ireland.5 Those involved in the academic or professional development of future generations of architects are also concerned about the relevance of a post-conflict condition. As a profession, if architects purport to be concerned with context, then the almost tangible socio-political circumstances and legacy of Northern Ireland does inevitably require direct eye contact. This paper therefore aims to bring the relationship between conflict and architectural practice in Northern Ireland into sharp focus, not to constrain or dull creative practice but to heighten its potential.

School Ethos and Governor Relationships

This paper argues that an understanding of ethos is essential for appreciating the process of policy implementation in schools. Whilst educational literature consistently refers to the importance of ethos as a means of understanding the distinctive nature of schools, there is little exploration of school ethos as an effective mediator of policy. Drawing on qualitative data collected in three primary schools it will be demonstrated how ethos can act as a bridge or a barrier to the successful construction of the model of collaborative relationships between school governors and heads, as set out by the education reform legislation of the late 1980s

How counselling psychologists view their personal therapy

A survey of UK chartered counselling psychologists (N = 192) was carried out to investigate how they viewed their personal therapy. Eighty-four respondents completed questionnaires about their reasons and motivations for therapy, as well as its outcome and process. The results indicated that the majority (88%) were in favour of personal therapy as a training requirement. Most respondents rated the outcome and process of their personal therapy as positive, however 27% also reported some negative effects. A factor analysis of various components of personal therapy indicated that counselling psychologists made a distinction between three factors, i.e. learning about therapy itself, issues arising out of training and dealing with personal issues. Analyses of the data suggested that aims and motivation for therapy were related to dealing with personal issues, whereas these were not important for the other factors. Learning about therapy itself was related to the number of sessions: more specifically, chose who had more than the mandatory 40 sessions rated contributions of their personal therapy co understanding therapeutic relationships and processes more highly than those who had less. Initial sessions may be used by trainees to explore personal issues, leading to a preoccupation with the self, and learning about therapy per se may only occur once this has been dealt with.

Transaction Costs and Organizational Learning in Strategic Oursourcing Relationships

The present paper examines the role of organisational learning and transaction costs economics in strategic outsourcing decisions. Interorganisational learning is critical to competitive success, and organisations often learn more effectively by collaborating with other organisations. However, learning processes may also complicate the process of forming interorganisational partnerships which may increase transaction costs. Based on the literature, the authors develop refutable implications for outsourcing supply chain logistics and a sample of 121 firms in the supply chain logistics industry is used to test the hypotheses. The results show that trust and transaction costs are significant and substantial drivers of strategic outsourcing of supply chain logistics (a strategic flexibility action). Learning intent and knowledge acquisition have no significant influence on the decision to outsource supply chain logistics. The paper concludes with a discussion of the different and often conflicting implications for managing interorganisational learning processes.

Relationships between human sperm protamines, DNA damage and assisted reproduction outcomes

The exchange of histones with protamines in sperm DNA results in sperm chromatin compaction and protection. Variations in sperm protamine expression are associated with male infertility. The aim of this study was to investigate relationships between DNA fragmentation, sperm protamines and assisted reproduction treatment. Semen and spermatozoa prepared by density-gradient centrifugation (DGC) from 73 men undergoing IVF and 24 men undergoing intracytoplasmic sperm injection (ICSI) were included in the study. Nuclear DNA fragmentation was assessed using the alkaline Comet assay and protamines were separated by acid-urea polyacrylamide gels. Sperm DNA fragmentation and protamine content (P1-DNA, P2-DNA, P1 + P2-DNA) decreased in spermatozoa after DGC. Abnormally high and low P1/P2 ratios were associated with increased sperm DNA fragmentation. Couples with idiopathic infertility had abnormally high P1/P2 ratios. Fertilization rates and embryo quality decreased as sperm DNA fragmentation or protamines increased. Sperm DNA fragmentation was lower in couples achieving pregnancies after IVF, but not after ICSI. There was no correlation between protamine content (P1-DNA, P2-DNA, P1 + P2-DNA) or P1/P2 ratios and IVF or ICSI pregnancies. Increased sperm DNA fragmentation was associated with abnormal protamination and resulted in lower fertilization rates, poorer embryo quality and reduced pregnancy rates. During late spermatogenesis, around 85% of the histones in the sperm nucleus are replaced with protamines. This process results in sperm chromatin compaction and also transcription silencing. In the human, protamines are comprised of two types: protamine-1 (P1) and protamine-2 (P2). Variations in sperm protamine expression are associated with male infertility. Similarly, sperm DNA integrity is important for male fertility. The aim of this study was to investigate relationships between DNA fragmentation, sperm protamines and assisted reproduction treatment. Semen and spermatozoa prepared by density-gradient centrifugation (DGC) from 73 men undergoing IVF and 24 men undergoing intracytoplasmic sperm injection (ICSI) were included in the study. Nuclear DNA fragmentation was assessed using the alkaline Comet assay and protamines were separated by acid-urea polyacrylamide gels. Sperm DNA fragmentation and protamine content decreased in spermatozoa after DGC. Abnormally high and low P1/P2 ratios were associated with increased sperm DNA fragmentation. Couples with idiopathic infertility had abnormally high P1/P2 ratios. Fertilization rates and embryo quality decreased as sperm DNA fragmentation or protamines increased. Sperm DNA fragmentation was lower in couples achieving pregnancies after IVF, but not after ICSI. There was no correlation between protamine content or P1/P2 ratios and IVF or ICSI pregnancies. Increased sperm DNA fragmentation was associated with abnormal protamination and resulted in lower fertilization rates, poorer embryo quality and reduced pregnancy rates.

The Supremacy of the Sequence: Key Elements and Dimensions in the Process of Change

How single organizations manage the process of change and why only some of them are able to actually reach radical change are central questions in today’s theoretical debate. The role played by the process of change and its dimensions (namely, pace, sequence and linearity), however, has been poorly investigated. Drawing on archetype theory, this paper explores: (i) whether a specific pace of radical change exists; (ii) whether different outcomes of change are characterized by different sequences of change in key-structures and systems (iii) how the three dimensions of the process of change possibly interact. As an example of organizational change the study takes into consideration processes of accounting change in three departments of two Canadian and two Italian municipalities. The results suggest the supremacy of the sequence of implemented changes over the other two dimensions of the process in order to achieve a radical outcome of change.

Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery.

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic burden both in western and developing countries, in which this burden is increasing in close correlation to economic growth. Health authorities and the general population have started to recognize that the fight against these diseases can only be won if their burden is faced by increasing our investment on interventions in lifestyle changes and prevention. There is an overwhelming evidence of the efficacy of secondary prevention initiatives including cardiac rehabilitation in terms of reduction in morbidity and mortality. However, secondary prevention is still too poorly implemented in clinical practice, often only on selected populations and over a limited period of time. The development of systematic and full comprehensive preventive programmes is warranted, integrated in the organization of national health systems. Furthermore, systematic monitoring of the process of delivery and outcomes is a necessity. Cardiology and secondary prevention, including cardiac rehabilitation, have evolved almost independently of each other and although each makes a unique contribution it is now time to join forces under the banner of preventive cardiology and create a comprehensive model that optimizes long term outcomes for patients and reduces the future burden on health care services. These are the aims that the Cardiac Rehabilitation Section of the European Association for Cardiovascular Prevention & Rehabilitation has foreseen to promote secondary preventive cardiology in clinical practice.

It's all about relationships:A qualitative study of health researchers' perspectives of conducting interdisciplinary health research

Background. Interdisciplinary research has been promoted as an optimal research paradigm in the health sciences, yet little is known about how researchers experience interdisciplinarity in practice. This study sought to determine how interdisciplinary research was conceptualized and operationalized from the researcher's perspective and to better understand how best to facilitate interdisciplinary research success. Methods. Key informant interviews were conducted with health researchers with expertise or experience in conducting interdisciplinary research. Interviews were completed either in person or over the telephone using a semi-structured interview guide. Data collection occurred simultaneously with data analysis so that emerging themes could be explored in subsequent interviews. A content analysis approach was used. Results. Nineteen researchers took part in this study. Interdisciplinary research was conceptualized disparately between participants, and there was modest attention towards operationalization of interdisciplinary research. There was one overriding theme, "It's all about relationships", that emerged from the data. Within this theme, there were four related subthemes: 1) Involvement in interdisciplinary research; 2) Why do I do interdisciplinary research?; 3) Managing and fostering interdisciplinary relationships; and 4) The prickly side to interdisciplinary research. Together, these themes suggest that the choice to conduct interdisciplinary research, though often driven by the research question, is highly influenced by interpersonal and relationship-related factors. In addition, researchers preferred to engage in interdisciplinary research with those that they had already established relationships and where their role in the research process was clearly articulated. A focus on relationship building was seen as a strong facilitator of interdisciplinary success. Conclusion. Many health researchers experienced mixed reactions towards their involvement in interdisciplinary research. A well thought-out rationale for interdisciplinary research, and strategies to utilize the contribution of each researcher involved were seen as facilitators towards maximizing the benefits that could be derived from interdisciplinary research. © 2008 Nair et al; licensee BioMed Central Ltd.

Hyperglycemia and adverse pregnancy outcome study:Neonatal glycemia

OBJECTIVE: The goal was to describe the temporal pattern of neonatal plasma glucose levels and associations with maternal glucose levels, cord serum C-peptide levels, and neonatal size and adiposity. METHODS: A total of 17 094 mothers and infants were included in the Hyperglycemia and Adverse Pregnancy Outcome Study (15 centers in 9 countries). Mothers underwent a 75-g, 2-hour, oral glucose tolerance test (OGTT) at 24 to 32 weeks of gestation. Cord blood and neonatal blood samples were collected. Biochemical neonatal hypoglycemia was defined as glucose levels of 90th percentile. CONCLUSIONS: Mean neonatal plasma glucose concentrations varied little in the first 5 hours after birth, which suggests normal postnatal adjustment. Biochemical and clinical hypoglycemia were weakly related to maternal OGTT glucose measurements but were strongly associated with elevated cord serum C-peptide levels. Larger and/or fatter infants were more likely to develop hypoglycemia and hyperinsulinemia. These relationships suggest physiologic relationships between maternal glycemia and fetal insulin production. Copyright © 2010 by the American Academy of Pediatrics.

Using Mesh-Geometry Relationships to Transfer Analysis Models between CAE Tools

Integrating analysis and design models is a complex task due to differences between the models and the architectures of the toolsets used to create them. This complexity is increased with the use of many different tools for specific tasks during an analysis process. In this work various design and analysis models are linked throughout the design lifecycle, allowing them to be moved between packages in a way not currently available. Three technologies named Cellular Modeling, Virtual Topology and Equivalencing are combined to demonstrate how different finite element meshes generated on abstract analysis geometries can be linked to their original geometry. Establishing the equivalence relationships between models enables analysts to utilize multiple packages for specialist tasks without worrying about compatibility issues or rework.