Promoting clinical reasoning in general practice trainees: role of the clinical teacher

BACKGROUND: Clinical reasoning requires knowledge, cognition and metacognition, and is contextually bound. Clinical teachers can and should play a key role in explicitly promoting clinical reasoning.

CONTEXT: The aim of this article is to relate the clinical reasoning literature to the general practice or family medicine context, and to provide clinical teachers with strategies to promote clinical reasoning.

INNOVATION: It is important that the clinical teacher teaches trainees the specific skills sets of the expert general practitioner (e.g. synthesising skills, recognising prototypes, focusing on cues and clues, using community resources and dealing with uncertainty) in order to promote clinical reasoning in the context of general practice or family medicine. Clinical teachers need to understand their own reasoning processes as well as be able to convey that knowledge to their trainees. They also need to understand the developmental stages of clinical reasoning and be able to nurture each trainee's own expertise. Strategies for facilitating effective clinical reasoning in trainees include adequate exposure to patients, offering the trainees opportunity for reflection and feedback, and coaching on the techniques of reasoning in the general practice context.

IMPLICATIONS: The journey to expertise in clinical reasoning is unique to each clinician, with different skills developing at different rates, depending on content, context and past experience. Doctors enter into general practice training with the building blocks of biomedical and clinical knowledge and a desire to learn how to be a general practitioner. Clinical teachers are integral in the process of helping trainees learn how to 'think like a general practitioner'.

Advances in wrought magnesium alloys: Fundamentals of processing, properties and applications

This important book summarises the wealth of recent research on our understanding of process-property relationships in wrought magnesium alloys and the way this understanding can be used to develop a new generation of alloys for high-performance applications. After an introductory overview of current developments in wrought magnesium alloys, part one reviews fundamental aspects of deformation behaviour. These chapters are the building blocks for the optimisation of processing steps covered in part two, which discusses casting, extrusion, rolling and forging technologies. The concluding chapters cover applications of wrought magnesium alloys in automotive and biomedical engineering. With its distinguished editors, and drawing on the work of leading experts in the field, Advances in wrought magnesium alloys is a standard reference for those researching, manufacturing and using these alloys.

A non-fullerene electron acceptor based on central carbazole and terminal diketopyrrolopyrrole functionalities for efficient, reproducible and solution-processable bulk-heterojunction devices

A novel, solution-processable non-fullerene electron acceptor, 6,6′-((9-(heptadecan-9-yl)-9H-carbazole-2,7-diyl)bis(thiophene-5,2-diyl))bis(2,5-bis(2-ethylhexyl)-3-(thiophen-2-yl)-2,5-dihydropyrrolo[3,4-c]pyrrole-1,4-dione) (coded as N7), based on central carbazole and terminal diketopyrrolopyrrole building blocks was designed, synthesized and characterized. N7 displayed excellent solubility, thanks to its design allowing incorporation of numerous lipophilic chains, thermal stability, and afforded a 2.30% power conversion efficiency with a high open-circuit voltage (1.17 V) when tested with the conventional donor polymer poly(3-hexylthiophene) in solution-processable bulk-heterojunction devices. To our knowledge, not only is N7 the first reported chromophore based on carbazole and diketopyrrolopyrrole functionalities but the open-circuit voltage reported here is among the highest values for a single junction bulk-heterojunction device that has been fabricated using a simple device architecture, with reproducible outcomes and with no special treatment.

Online stretching of directly electrospun nanofiber yarns

Nanofiber yarns are important building blocks for making three-dimensional nanostructures, e.g. through a knitting or weaving process, with better mechanical properties than nanofiber nonwovens and well-controlled fibrous construction. However, it still remains challenging to produce quality nanofiber yarns in a sufficient rate. In this study, we have proven that online stretching during electrospinning of nanofiber yarns can considerably improve fiber alignment and molecular orientation within the yarn and increase yarn tensile strength, but reduce fiber/yarn diameters. By compensating twist during online stretching, the device can prepare nanofiber yarns with different stretch levels, but maintaining the same twist multiplier. This allows us to examine the effect of stretching on fiber and yarn morphology. It was interesting to find that on increasing the stretching ratio from 0% to 95%, the yarn diameter reduced from 135.1 ± 20.3 μm to 46.2 ± 10.2 μm, and the fiber diameter reduced from 998 ± 141 nm to 631 ± 98 nm, whereas the yarn tensile strength increased from 48.2 ± 5.6 MPa to 127.7 ± 5.4 MPa. Such an advanced yarn electrospinning technique can produce nanofiber yarn with an overall yarn production rate as high as 10 m min−1. This may be useful for production of nanofiber yarns for various applications.

Building the second generation of parallel/distributed virtual reality systems

We present the RhoVeR (Rhodes Virtual Reality) system and classify it as a second generation parallel/distributed virtual reality (DVR) system. We discuss the components of the system and thereby demonstrate its support for virtual reality application development, its configurable, parallel and distributed nature, and its synthesis of first generation DVR techniques.

Special issue: Building secure parallel and distributed networks and systems

Security and privacy have been the major concern when people build parallel and distributed networks and systems. While the attack systems have become more easy-to-use, sophisticated, and powerful, interest has greatly increased in the field of building more effective, intelligent, adaptive, active and high performance defense systems which are distributed and networked. This special issue focuses on the issues of building secure parallel and distributed networks and systems.

Development of DAL and DAPL languages for building distributed applications

A common characteristic among parallel/distributed programming languages is that the one language is used to specify not only the overall organisation of the distributed application, but also the functionality of the application. That is, the connectivity and functionality of processes are specified within a single program. Connectivity and functionality are independent aspects of a distributed application. This thesis shows that these two aspects can be specified separately, therefore allowing application designers to freely concentrate on either aspect in a modular fashion. Two new programming languages have been developed for specifying each aspect. These languages are for loosely coupled distributed applications based on message passing, and have been designed to simplify distributed programming by completely removing all low level interprocess communication. A suite of languages and tools has been designed and developed. It includes the two new languages, parsers, a compilation system to generate intermediate C code that is compiled to binary object modules, a run-time system to create, manage and terminate several distributed applications, and a shell to communicate with the run-tune system. DAL (Distributed Application Language) and DAPL (Distributed Application Process Language) are the new programming languages for the specification and development of process oriented, asynchronous message passing, distributed applications. These two languages have been designed and developed as part of this doctorate in order to specify such distributed applications that execute on a cluster of computers. Both languages are used to specify orthogonal components of an application, on the one hand the organisation of processes that constitute an application, and on the other the interface and functionality of each process. Consequently, these components can be created in a modular fashion, individually and concurrently. The DAL language is used to specify not only the connectivity of all processes within an application, but also a cluster of computers for which the application executes. Furthermore, sub-clusters can be specified for individual processes of an application to constrain a process to a particular group of computers. The second language, DAPL, is used to specify the interface, functionality and data structures of application processes. In addition to these languages, a DAL parser, a DAPL parser, and a compilation system have been designed and developed (in this project). This compilation system takes DAL and DAPL programs to generate object modules based on machine code, one module for each application process. These object modules are used by the Distributed Application System (DAS) to instantiate and manage distributed applications. The DAS system is another new component of this project. The purpose of the DAS system is to create, manage, and terminate many distributed applications of similar and different configurations. The creation procedure incorporates the automatic allocation of processes to remote machines. Application management includes several operations such as deletion, addition, replacement, and movement of processes, and also detection and reaction to faults such as a processor crash. A DAS operator communicates with the DAS system via a textual shell called DASH (Distributed Application SHell). This suite of languages and tools allowed distributed applications of varying connectivity and functionality to be specified quickly and simply at a high level of abstraction. DAL and DAPL programs of several processes may require a few dozen lines to specify as compared to several hundred lines of equivalent C code that is generated by the compilation system. Furthermore, the DAL and DAPL compilation system is successful at generating binary object modules, and the DAS system succeeds in instantiating and managing several distributed applications on a cluster.

Design of multiple sequence alignment algorithms on parallel, distributed memory supercomputers

The challenge of comparing two or more genomes that have undergone recombination and substantial amounts of segmental loss and gain has recently been addressed for small numbers of genomes. However, datasets of hundreds of genomes are now common and their sizes will only increase in the future. Multiple sequence alignment of hundreds of genomes remains an intractable problem due to quadratic increases in compute time and memory footprint. To date, most alignment algorithms are designed for commodity clusters without parallelism. Hence, we propose the design of a multiple sequence alignment algorithm on massively parallel, distributed memory supercomputers to enable research into comparative genomics on large data sets. Following the methodology of the sequential progressiveMauve algorithm, we design data structures including sequences and sorted k-mer lists on the IBM Blue Gene/P supercomputer (BG/P). Preliminary results show that we can reduce the memory footprint so that we can potentially align over 250 bacterial genomes on a single BG/P compute node. We verify our results on a dataset of E.coli, Shigella and S.pneumoniae genomes. Our implementation returns results matching those of the original algorithm but in 1/2 the time and with 1/4 the memory footprint for scaffold building. In this study, we have laid the basis for multiple sequence alignment of large-scale datasets on a massively parallel, distributed memory supercomputer, thus enabling comparison of hundreds instead of a few genome sequences within reasonable time.

Building genetic networks using relatedness information : a novel approach for the estimation of dispersal and characterization of group structure in social animals

Natal dispersal is an important life history trait driving variation in individual fitness, and therefore, a proper understanding of the factors underlying dispersal behaviour is critical to many fields including population dynamics, behavioural ecology and conservation biology. However, individual dispersal patterns remain difficult to quantify despite many years of research using direct and indirect methods. Here, we quantify dispersal in a single intensively studied population of the cooperatively breeding chestnut-crowned babbler (Pomatostomus ruficeps) using genetic networks created from the combination of pairwise relatedness data and social networking methods and compare this to dispersal estimates from re-sighting data. This novel approach not only identifies movements between social groups within our study sites but also provides an estimation of immigration rates of individuals originating outside the study site. Both genetic and re-sighting data indicated that dispersal was strongly female biased, but the magnitude of dispersal estimates was much greater using genetic data. This suggests that many previous studies relying on mark–recapture data may have significantly underestimated dispersal. An analysis of spatial genetic structure within the sampled population also supports the idea that females are more dispersive, with females having no structure beyond the bounds of their own social group, while male genetic structure expands for 750 m from their social group. Although the genetic network approach we have used is an excellent tool for visualizing the social and genetic microstructure of social animals and identifying dispersers, our results also indicate the importance of applying them in parallel with behavioural and life history data.

Channel estimation of dual-hop MIMO relay system via parallel factor analysis

The optimal source precoding matrix and relay amplifying matrix have been developed in recent works on multiple-input multiple-output (MIMO) relay communication systems assuming that the instantaneous channel state information (CSI) is available. However, in practical relay communication systems, the instantaneous CSI is unknown, and therefore, has to be estimated at the destination node. In this paper, we develop a novel channel estimation algorithm for two-hop MIMO relay systems using the parallel factor (PARAFAC) analysis. The proposed algorithm provides the destination node with full knowledge of all channel matrices involved in the communication. Compared with existing approaches, the proposed algorithm requires less number of training data blocks, yields smaller channel estimation error, and is applicable for both one-way and two-way MIMO relay systems with single or multiple relay nodes. Numerical examples demonstrate the effectiveness of the PARAFAC-based channel estimation algorithm.

Efficacy of nefazodone in the treatment of neuroleptic induced extrapyramidal side effects: a double-blind randomised parallel group placebo-controlled trial.

Many atypical antipsychotics show antagonism at both serotonergic and dopaminergic neurones and show fewer extrapyramidal side effects (EPS). Nefazodone blocks postsynaptic 5HT2A receptors and weakly inhibits serotonin reuptake. This study aimed to elucidate the role of nefazodone in the treatment of antipsychotic-induced EPS. The trial was a double-blind, randomised, placebo-controlled trial of patients requiring antipsychotic treatment with haloperidol 10mg daily; from which a subgroup of patients who developed EPS were selected for the study. Patients were randomised to add-on therapy with either placebo (n=24) or nefazodone (n=25) 100mg bd. EPS were measured on days 0, 3 and 7 using the Simpson Angus, Barnes akathisia, abnormal involuntary movement and Chouinard scales. Nefazodone significantly reduced EPS as measured by both the Simpson Angus scale and CGI (p=0.007 and 0.0247, respectively). Akathisia and tardive dyskinesia did not differ between the two groups (p=0.601; p=0.507, respectively). These results suggest the role of 5HT2 antagonism in the mechanism of action of atypical antipsychotics with respect to lowering rates of drug-induced EPS. In addition, a therapeutic role for nefazodone is suggested in the treatment of antipsychotic-induced EPS.

Brutalism, metabolism and its American parallel : encounters in Skopje and in the architecture of Georgi Konstantinovski

Abstract Massive, raw concrete structures – the likes of the Telecommunications Building (1972–81) by Janko Konstantinov; the campus of Ss. Cyril and Methodius University (1974) by Marko Musˇicˇ; the National Hydraulic Institute (1972) by Krsto Todorovski; and the Bank Complex (1970) by R. Lalovik and O. Papesˇ – have led to the production of an enduring monumental presence and helped inspire Skopje’s title as the “Brutalist capital of the world”. These works followed Kenzo Tange’s introduction of Japanese Metabolism to Skopje through his role in the 1965 United Nations sponsored reconstruction competition. The unique position of a Non-Aligned Yugoslavia staged and facilitated architectural and professional exchange during the Cold War. Each trajectory and manifestation illustrates the complex picture of international architectural exchange and local production. Skopje and its numerous Brutalist edifices is an elucidative story, because it represents a meeting point between Brutalism, Metabolism and its American parallel. This article discusses, in particular, the Skopje Archive Building (1966) and the “Goce Delcˇev” Student Dormitory (1969) – two buildings designed by the architect Georgi Konstantinovski, realised on his return from a Masters program at Yale University and employment within I. M. Pei’s New York office. Their architecture illustrates the simultaneous preoccupations of leading architects at the time in regaining a conceptual ground made explicit through a complete and apprehensible image. From this particular position, the article explores the question of ethics and aesthetics central to Banham’s outline of the “New Brutalism”.

Tokyo’s Dojunkai experiment: courtyard apartment blocks 1926–1932

Dojunkai apartments were constructed by the Japanese Government as a work of relief, after the Great Kanto Earthquake in Tokyo. These apartments were leading examples in concrete construction in Japan and were innovative in their exterior space design ideas and building organizational themes. Dojunkai apartments were designed not only as solutions to particular sites, but as possible models for the further development of well-planned, secure, and communal neighbourhood style residential developments. During 1920–1930, Japanese architects and designers were actively involved in experimenting with foreign concepts of urban remodelling and town planning. However while these town-planning concepts and theories were embraced by Japanese architects and town planners, the resultant apartment complexes suggest that they endeavoured to adapt and transform them to suit Japanese sensibilities and urban requirements. This paper examines the nature of these adaptations and transformations. The principles of exterior space design are deployed to examine and identify patterns in building arrangement and exterior space design for six selected Dojunkai apartments. This paper discusses the pre-existing models of urban planning in Japan to establish a relationship between the adopted foreign town-planning models and the pre-existing ideas of urban settlements in the Japanese society.