Recruitment to higher specialty training in anaesthesia in the UK during the COVID-19 pandemic: a national survey.

There were more applications for higher specialty training posts in anaesthesia in the UK starting in August 2021 than in previous years, with approximately two-thirds being unsuccessful. We surveyed applicants to investigate their experience of the recruitment process (response rate 536/1056; 51%). Approximately 61% of respondents were not offered ST3 posts (n = 326). We enquired about their career plans for the next 12-24 months. Most respondents (79%) intended to take up a post equivalent to a third year of core training or a clinical fellow post from August 2021. Other options considered included: pursuing work abroad (17%); embarking on career breaks (16%); taking up higher training posts in intensive care medicine (15%); and permanently leaving medicine (9%). Nine per cent of respondents also expressed plans to pursue training in another medical specialty. Some expressed an intention to pursue further education or research (10%). A large proportion (42%) expressed a lack of confidence in being able to achieve the training requirements to later apply for a higher training post. The majority reported not feeling confident in achieving specialist registration in anaesthesia in the future without a training number (75%), and noted disruption to their wider life plans from the impending time out of training (78%). Sentiment analysis of free-text responses indicated generally negative sentiment about the recruitment process. Themes elicited included: feeling the recruitment process was unfair; burnout and negative impact on well-being; difficulties in making life plans; and feeling undervalued and abandoned. These results suggest that junior anaesthetic doctors in the UK negatively perceived postgraduate training structures and changes to the postgraduate curriculum and experienced difficulties in securing higher training.

Tailored optical vector fields for ultrashort-pulse laser induced complex surface plasmon structuring.

Precise tailoring of optical vector beams is demonstrated, shaping their focal electric fields and used to create complex laser micro-patterning on a metal surface. A Spatial Light Modulator (SLM) and a micro-structured S-waveplate were integrated with a picosecond laser system and employed to structure the vector fields into radial and azimuthal polarizations with and without a vortex phase wavefront as well as superposition states. Imprinting Laser Induced Periodic Surface Structures (LIPSS) elucidates the detailed vector fields around the focal region. In addition to clear azimuthal and radial plasmon surface structures, unique, variable logarithmic spiral micro-structures with a pitch Λ âˆ¼1µm, not observed previously, were imprinted on the surface, confirming unambiguously the complex 2D focal electric fields. We show clearly also how the Orbital Angular Momentum(OAM) associated with a helical wavefront induces rotation of vector fields along the optic axis of a focusing lens and confirmed by the observed surface micro-structures.

Complete wavefront and polarization control for ultrashort-pulse laser microprocessing.

We report on new developments in wavefront and polarization control for ultrashort-pulse laser microprocessing. We use two Spatial Light Modulators in combination to structure the optical fields of a picosecond-pulse laser beam, producing vortex wavefronts and radial or azimuthal polarization states. We also carry out the first demonstration of multiple first-order beams with vortex wavefronts and radial or azimuthal polarization states, produced using Computer Generated Holograms. The beams produced are used to nano-structure a highly polished metal surface. Laser Induced Periodic Surface Structures are observed and used to directly verify the state of polarization in the focal plane and help to characterize the optical properties of the setup.

Dynamic modulation of spatially structured polarization fields for real-time control of ultrafast laser-material interactions.

The polarization state of an ultrafast laser is dynamically controlled using two Spatial Light Modulators and additional waveplates. Consequently, four states of polarization, linear horizontal and vertical, radial and azimuthal, all with a ring intensity distribution, were dynamically switched at a frequency ν = 12.5 Hz while synchronized with a motion control system. This technique, demonstrated here for the first time, enables a remarkable level of real-time control of the properties of light waves and applied to real-time surface patterning, shows that highly controlled nanostructuring is possible. Laser ablation of Induced Periodic Surface Structures is used to directly verify the state of polarization at the focal plane.

The influences of particle number on hot spots in strongly coupled metal nanoparticles chain.

In understanding of the hot spot phenomenon in single-molecule surface enhanced Raman scattering (SM-SERS), the electromagnetic field within the gaps of dimers (i.e., two particle systems) has attracted much interest as it provides significant field amplification over single isolated nanoparticles. In addition to the existing understanding of the dimer systems, we show in this paper that field enhancement within the gaps of a particle chain could maximize at a particle number N>2, due to the near-field coupled plasmon resonance of the chain. This particle number effect was theoretically observed for the gold (Au) nanoparticles chain but not for the silver (Ag) chain. We attribute the reason to the different behaviors of the dissipative damping of gold and silver in the visible wavelength range. The reported effect can be utilized to design effective gold substrate for SM-SERS applications.

Three novel COLQ mutations and variation of phenotypic expressivity due to G240X.

OBJECTIVE: To determine the molecular basis and consequences of endplate (EP) acetylcholinesterase (AChE) deficiency. BACKGROUND: The EP species AChE is an asymmetric enzyme consisting of a tail subunit composed of three collagenic strands (ColQ), each attached to a tetramer of catalytic subunits. The tail subunit is essential for insertion of AChE into the synaptic basal lamina. Human EP AChE deficiency is caused by mutations in COLQ. The authors report three novel COLQ mutations in eight kinships. METHODS: Immunocytochemistry, electron microscopy, microelectrode recordings, mutation analysis, and expression studies in COS cells were employed. RESULTS: Two mutations (275insC and Q211X) were heterozygous in one patient. EP studies in this patient revealed no EP AChE, small nerve terminals, reduced presynaptic membrane length, as well as abnormally low-evoked quantal release. The third mutation (G240X) was homozygous in six Palestinian Arab families of the same tribe and in an Iraqi Jewish patient. Expression studies of the three mutations in COS cells indicate that each abrogates formation of insertion competent asymmetric AChE. Although the three mutations have identical predicted consequences at the EP, their phenotypic expressivity varies as regards age at onset, rate of progression, and severity of symptoms. CONCLUSIONS: 1) After mutations in the AChR epsilon subunit, mutations in COLQ are emerging as second most common cause of congenital myasthenic syndromes. 2) A founder effect is likely for G240X in the Palestinian Arab families. 3) That mutations predicting total absence of AChE from the EP have variable phenotypic expressivity suggests that modifying genes or environmental factors can partially compensate for EP AChE deficiency.

Fagopyritols, D-chiro-inositol, and other soluble carbohydrates in buckwheat seed milling fractions.

Fagopyritols are mono-, di-, and trigalactosyl derivatives of D-chiro-inositol that accumulate in seeds of common buckwheat (Fagopyrum esculentum Moench) and may be important for seed maturation and as a dietary supplement. Fagopyritols and other soluble carbohydrates were assayed in mature groats and 11 milling fractions of common buckwheat seed. Because fagopyritols are in embryo and aleurone tissues, differences in fagopyritol concentrations reflect varying proportions of these tissues in each milling fraction. Bran milling fractions contained 6.4 g of total soluble carbohydrates per 100 g of dry weight, 55% of which was sucrose and 40% fagopyritols. Flour milling fractions had reduced fagopyritol concentration [0.7 g/100 g of dry weight total fagopyritols in the dark (Supreme) flour and 0.3 g/100 g in the light (Fancy) flours]. Fagopyritol B1 was 70% of total fagopyritols in all milling fractions. Fagopyritols were 40% of total soluble carbohydrates in groats of two cultivars of common buckwheat but 21% in groats of tartary buckwheat [Fagopyrum tataricum (L.) Gaertn.], probably a reflection of environment and genetics. A rhamnoglucoside present in tartary buckwheat was not detected in common buckwheat.

The consequences and opportunities of shortened lengths of stay for cardiovascular patients.

Length of hospitalization for many cardiovascular conditions has decreased dramatically recently. Many attribute this increase to the cost constraints imposed by managed care and to improved technologies. Although technological developments have contributed to cost inflation, they have also reduced the need for long hospitalizations and improved patient outcomes. This new context for delivering cardiovascular services is discussed in terms of the challenges and opportunities for nursing leadership in several aspects of care.

Appropriateness of self-care responses to symptoms among elders: identifying pathways of influence.

The purpose of the study was to investigate the separate and joint influences of sociodemographic, social situational (social support and interpersonal functioning), and symptom variables on the appropriateness of self-care responses to symptoms among elderly people. A cross-sectional face-to-face structured interview of a sample of noninstitutionalized, English-speaking persons 65 and older living in Minneapolis was used. The theoretical framework for the investigation was tested using graphical modeling techniques. A majority of the subjects responded appropriately to the symptoms they experienced. Gender was a key variable in understanding which of the sociodemographic, social support, interpersonal functioning, and symptom variables were related to the likelihood that individuals would engage in appropriate self-care. There appear to be fundamental differences in the influence of the social situational variables for men and women. If these results are confirmed in future studies, different intervention strategies may be needed for assisting elderly men and women in interpreting and responding to their symptoms.

Symptom consultation in lay networks in an elderly population.

Although lay referrals are known to be important as factors affecting the use of professional services, less is known about how individuals use lay consultation in evaluating symptoms. The amount and type of advice given by persons in the social network is especially important with respect to self care of symptoms that never reach the attention of professional caregivers. This article provides information on how often and from whom elderly citizens seek and receive consultation, such as family and friends, when they experience common symptoms. Findings suggest that female relatives are important sources of advice but that neither gender nor living arrangements are closely related to the tendency to seek lay advice for common symptoms. Subjects who consulted lay advisers about arthritic symptoms also were more likely to seek professional consultation.

Differences in cord serum retinol concentrations by ethnic origin in the Negev (southern Israel).

Subclinical vitamin A deficiency is related to increased morbidity and mortality in infants and children. Previous studies indicate that the traditional diet of Moslem Bedouins, an important ethnic group in Southern Israel, is low in vitamin A content. Cord serum retinol (vitamin A) concentration was measured by HPLC in samples from 251 apparently healthy (birth weight > 2500 g, gestational age > 37 weeks) neonates with no abnormal perinatal events, 138 Jews and 113 Bedouins. Retinol < 15 micrograms/dl was measured in a total of 14% of infants: in 7% of Jewish and 26% of Bedouin newborns (P < 0.001). However, mean cord serum retinol was only slightly lower in Bedouins than in Jews (30 +/- 26 vs. 37 +/- 27 micrograms/dl mean +/- S.D., n.s.). Cord serum retinol was not related to socioeconomic indices. Cord serum retinol < 15 micrograms/dl was measured in 25% and in 12% of infants with birth weight less than and equal or greater than 3000 g, respectively (P = 0.01), and in 28% and 13% of infants with gestational age 37-38 weeks and 39-41 weeks, respectively (P = 0.03). Low cord serum retinol was found to be prevalent in Southern Israel, particularly in Bedouin infants. In the population of healthy neonates studied, very low cord serum retinol concentrations were found more frequently in infants born with a lower weight and/or after a shorter gestation.

A computer assisted tutorial for applications of computer spreadsheets in nursing financial management.

A computer-based tutorial for teaching nursing financial management concepts was developed using the macro function of a commercially available spreadsheet program. The goals of the tutorial were to provide students with an experience with spreadsheets as a computer tool and to teach selected financial management concepts. Preliminary results show the tutorial was well received by students. Suggestions are made for overcoming the general lack of computer sophistication among students.

Costs and benefits of clinical nurse specialists.

The emphasis on cost containment during the 1980s has given way to a renewed interest in the quality of health care services that can be delivered at a reasonable cost. In this climate, clinical nurse specialists (CNSs) have an excellent opportunity to demonstrate the cost-effectiveness of their work. In order to do so, costs and benefits of CNS services must be measured and compared.