The rural medicine rotation: Increasing rural recruitment through quality undergraduate rural experiences

TITLE: The Rural Medicine Rotation: Increasing Rural Recruitment through Quality Undergraduate Rural Experiences Eley Diann, University of Queensland, School of Medicine, Rural Clinical Division, Toowoomba 4350, Queensland Australia Baker Peter, University of Queensland, School of Medicine Rural, Clinical Division, Toowoomba 4350, Queensland Australia Chater Bruce, University of Queensland, Chair, Clinical School Management Committee, School of Medicine Rural Clinical Division, Queensland Australia CONTEXT: While rural background and rural exposure during medical training increases the likelihood of rural recruitment (Wilkinson, 2003), the quality and content of that exposure is the key to altering undergraduatesâ?? perceptions of rural practice. The Rural Clinical Division at University of Queensland (UQ) runs the Rural Medicine Rotation (RMR) within the School of Medicine. The RMR is one of five eight week clinical rotations in Year three and is compulsory for all students. The RMR provides the opportunity to learn from a wide range of health professionals and clinical exposure is not restricted to general practice but also includes remote area nursing, Indigenous health care, allied health professionals and medical specialists. Week 1 involves preparation for their rural placement with workshops and seminars and Week 8 consolidates their placement and includes case and project presentations and a summative assessment. Weeks 2-7 are spent living and working as part of the health team in different rural communities. SETTING: Rural communities in and around Queensland including locations such as Arnham Land, Thursday Island, Mt. Isa and Alice Springs METHOD: All aspects of the RMR are evaluated with surveys using both qualitative and quantitative free response questions, completed by all students at the end of the Week 8. RESULTS: Overall the RMR is evaluated highly and narratives offered by students show that the RMR provides a positive rural experience. The overall impact of the RMR for students in 2004 ranked 3.45 on a scale of 1 to 4 (1 = lowest and 4 = highest), and is exemplified by the following quote; â??I enjoyed my placement so much I am now considering rural medicine something I definitely had not considered beforeâ??. OUTCOME: The positive impact of the RMR on studentâ??s perceptions of rural medicine is encouraging and can help achieve the overall aim of increasing recruitment of the rural workforce in Australia.

Cracks of higher modes in Cosserat continua

Rotational degrees of freedom in Cosserat continua give rise to higher fracture modes. Three new fracture modes correspond to the cracks that are surfaces of discontinuities in the corresponding components of independent Cosserat rotations. We develop a generalisation of J- integral that includes these additional degrees of freedom. The obtained path-independent integrals are used to develop a criterion of crack propagation for a special type of failure in layered materials with sliding layers. This fracture propagates as a progressive bending failure of layers – a “bending crack that is, a crack that can be represented as a distribution of discontinuities in the layer bending. This situation is analysed using a 2D Cosserat continuum model. Semi-infinite bending crack normal to layering is considered. The moment stress concentrates along the line that is a continuation of the crack and has a singularity of the power − 1/4. A model of process zone is proposed for the case when the breakage of layers in the process of bending crack propagation is caused by a crack (microcrack in our description) growing across the layer adjacent to the crack tip. This growth is unstable (in the moment-controlled loading), which results in a typical descending branch of moment stress – rotation discontinuity relationship and hence in emergence of a Barenblatt-type process zone at the tip of the bending crack.

Bayesian invariant measurements of generalisation for discrete distributions

Neural network learning rules can be viewed as statistical estimators. They should be studied in Bayesian framework even if they are not Bayesian estimators. Generalisation should be measured by the divergence between the true distribution and the estimated distribution. Information divergences are invariant measurements of the divergence between two distributions. The posterior average information divergence is used to measure the generalisation ability of a network. The optimal estimators for multinomial distributions with Dirichlet priors are studied in detail. This confirms that the definition is compatible with intuition. The results also show that many commonly used methods can be put under this unified framework, by assume special priors and special divergences.

Bayesian invariant measurements of generalisation for continuous distributions

A family of measurements of generalisation is proposed for estimators of continuous distributions. In particular, they apply to neural network learning rules associated with continuous neural networks. The optimal estimators (learning rules) in this sense are Bayesian decision methods with information divergence as loss function. The Bayesian framework guarantees internal coherence of such measurements, while the information geometric loss function guarantees invariance. The theoretical solution for the optimal estimator is derived by a variational method. It is applied to the family of Gaussian distributions and the implications are discussed. This is one in a series of technical reports on this topic; it generalises the results of ¸iteZhu95:prob.discrete to continuous distributions and serve as a concrete example of a larger picture ¸iteZhu95:generalisation.

Bayesian invariant measurements of generalisation

The problem of evaluating different learning rules and other statistical estimators is analysed. A new general theory of statistical inference is developed by combining Bayesian decision theory with information geometry. It is coherent and invariant. For each sample a unique ideal estimate exists and is given by an average over the posterior. An optimal estimate within a model is given by a projection of the ideal estimate. The ideal estimate is a sufficient statistic of the posterior, so practical learning rules are functions of the ideal estimator. If the sole purpose of learning is to extract information from the data, the learning rule must also approximate the ideal estimator. This framework is applicable to both Bayesian and non-Bayesian methods, with arbitrary statistical models, and to supervised, unsupervised and reinforcement learning schemes.

Objective analysis of toric intraocular lens rotation and centration

PURPOSE: To assess the repeatability of an objective image analysis technique to determine intraocular lens (IOL) rotation and centration. SETTING: Six ophthalmology clinics across Europe. METHODS: One-hundred seven patients implanted with Akreos AO aspheric IOLs with orientation marks were imaged. Image quality was rated by a masked observer. The axis of rotation was determined from a line bisecting the IOL orientation marks. This was normalized for rotation of the eye between visits using the axis bisecting 2 consistent conjunctival vessels or iris features. The center of ovals overlaid to circumscribe the IOL optic edge and the pupil or limbus were compared to determine IOL centration. Intrasession repeatability was assessed in 40 eyes and the variability of repeated analysis examined. RESULTS: Intrasession rotational stability of the IOL was ±0.79 degrees (SD) and centration was ±0.10 mm horizontally and ±0.10 mm vertically. Repeated analysis variability of the same image was ±0.70 degrees for rotation and ±0.20 mm horizontally and ±0.31 mm vertically for centration. Eye rotation (absolute) between visits was 2.23 ± 1.84 degrees (10%>5 degrees rotation) using one set of consistent conjunctival vessels or iris features and 2.03 ± 1.66 degrees (7%>5 degrees rotation) using the average of 2 sets (P =.13). Poorer image quality resulted in larger apparent absolute IOL rotation (r =-0.45,P<.001). CONCLUSIONS: Objective analysis of digital retroillumination images allows sensitive assessment of IOL rotation and centration stability. Eye rotation between images can lead to significant errors if not taken into account. Image quality is important to analysis accuracy.

Preparation, characterisation and entrapment of a non-glycosidic threitol ceramide into liposomes for presentation to invariant natural killer T cells

Dendritic cells (DCs) are able to present glycolipids to invariant natural killer T (iNKT) cells in vivo. Very few compounds have been found to stimulate iNKT cells, and of these, the best characterised is the glycolipid a-galactosylceramide, which stimulates the production of large quantities of interferon-gamma (IFN-?) and interleukin-4 (IL-4). However, aGalCer leads to overstimulation of iNKT cells. It has been demonstrated that the aGalCer analogue, threitol ceramide (ThrCer 2), successfully activates iNKT cells and overcomes the problematic iNKT cell activation-induced anergy. In this study, ThrCer 2 has been inserted into the bilayers of liposomes composed of a neutral lipid, 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC), or dimethyldioctadecylammonium bromide (DDA), a cationic lipid. Incorporation efficiencies of ThrCer within the liposomes was 96% for DSPC liposomes and 80% for DDA liposomes, with the vesicle size (large multilamellar vs. small unilamellar vesicles) making no significant difference. Langmuir-Blodgett studies suggest that both DSPC and DDA stack within the monolayer co-operatively with the ThrCer molecules with no condensing effect. In terms of cellular responses, IFN-? secretion was higher for cells treated with small DDA liposomes compared with the other liposome formulations, suggesting that ThrCer encapsulation in this liposome formulation resulted in a higher uptake by DCs.

A developmental dissociation of view-dependent and view-invariant object recognition in adolescence

Spatial generalization skills in school children aged 8-16 were studied with regard to unfamiliar objects that had been previously learned in a cross-modal priming and learning paradigm. We observed a developmental dissociation with younger children recognizing objects only from previously learnt perspectives whereas older children generalized acquired object knowledge to new viewpoints as well. Haptic and - to a lesser extent - visual priming improved spatial generalization in all but the youngest children. The data supports the idea of dissociable, view-dependent and view-invariant object representations with different developmental trajectories that are subject to modulatory effects of priming. Late-developing areas in the parietal or the prefrontal cortex may account for the retarded onset of view-invariant object recognition. © 2006 Elsevier B.V. All rights reserved.

Independent detectors for expansion and rotation, and for orthogonal components of deformation

It is well known that optic flow - the smooth transformation of the retinal image experienced by a moving observer - contains valuable information about the three-dimensional layout of the environment. From psychophysical and neurophysiological experiments, specialised mechanisms responsive to components of optic flow (sometimes called complex motion) such as expansion and rotation have been inferred. However, it remains unclear (a) whether the visual system has mechanisms for processing the component of deformation and (b) whether there are multiple mechanisms that function independently from each other. Here, we investigate these issues using random-dot patterns and a forced-choice subthreshold summation technique. In experiment 1, we manipulated the size of a test region that was permitted to contain signal and found substantial spatial summation for signal components of translation, expansion, rotation, and deformation embedded in noise. In experiment 2, little or no summation was found for the superposition of orthogonal pairs of complex motion patterns (eg expansion and rotation), consistent with probability summation between pairs of independent detectors. Our results suggest that optic-flow components are detected by mechanisms that are specialised for particular patterns of complex motion.