43 research outputs found
Education concerning HIV & elective attachments is the responsibility of Medical Schools
No full textResponse to Tai, NRM (2003) "Host should also protect students on electives from HIV
Test anxiety, working memory, and cognitive performance: Supportive effects of sequential demands
No full textSubstantial evidence suggests that test anxiety is associated with poor performance in complex tasks. Based on the differentiation of coordinative and sequential demands on working memory (Mayr & Kliegl, 1993), two studies examined the effects of sequential demands on the relationship between test anxiety and cognitive performance. Both studies found that high sequential demands had beneficial effects on the speed and accuracy of the performance of test-anxious participants. It is suggested that the more frequent memory updates associated with high sequential demands may represent external processing aids that compensate for the restricted memory capacity of individuals with high test anxiet
Combining data and meta-analysis to build Bayesian networks for clinical decision support
No full textAbstractComplex clinical decisions require the decision maker to evaluate multiple factors that may interact with each other. Many clinical studies, however, report ‘univariate’ relations between a single factor and outcome. Such univariate statistics are often insufficient to provide useful support for complex clinical decisions even when they are pooled using meta-analysis. More useful decision support could be provided by evidence-based models that take the interaction between factors into account. In this paper, we propose a method of integrating the univariate results of a meta-analysis with a clinical dataset and expert knowledge to construct multivariate Bayesian network (BN) models. The technique reduces the size of the dataset needed to learn the parameters of a model of a given complexity. Supplementing the data with the meta-analysis results avoids the need to either simplify the model – ignoring some complexities of the problem – or to gather more data. The method is illustrated by a clinical case study into the prediction of the viability of severely injured lower extremities. The case study illustrates the advantages of integrating combined evidence into BN development: the BN developed using our method outperformed four different data-driven structure learning methods, and a well-known scoring model (MESS) in this domain
In vivo femoropopliteal arterial wall compliance in subjects with and without lower limb vascular disease
No full textAbstractObjective: The purpose of this study was to further the development of a compliant vascular graft with a preliminary assessment of the elastic properties of the femoropopliteal artery in subjects with and without lower limb peripheral vascular disease. Methods: This prospective controlled study was set in a university department of surgery. Using an ultrasound scan wall tracking system with the simultaneous measurement of brachial blood pressure, measurements of femoropopliteal artery wall motion were undertaken in 11 patients with peripheral vascular disease (group 1), in 11 older control subjects who were matched for blood pressure, age, and sex (group 2), and in 12 younger control subjects (group 3). Diametrical compliance and stiffness index were determined for the common femoral artery, the proximal superficial femoral artery, the distal superficial femoral artery (DSFA), and the midgenicular popliteal artery. Results: All the arterial segments in group 1 showed a trend towards increased stiffness and less compliance than the group 2, age-matched control vessels, with significantly lower distensibility noted at the common femoral artery (mean compliance of 6.2% vs 14.1% mm Hg–1 × 10–2, respectively; P < .05) and the DSFA (mean compliance of 2.2% vs 1.9% mm Hg–1 × 10–2, respectively; P < .05). The popliteal artery segment in group 3 proved to be more compliant and less stiff than did the same vessel in group 2 (8.5% vs 4.7% mm Hg–1 × 10–2, respectively; P < .01). In all three study groups, the DSFA was consistently noted to be the least distensible vessel segment. Conclusion: Lower limb peripheral vascular disease is associated with a reduction in femoropopliteal artery elasticity. Age alone appears to have a minimal effect on the compliance of the proximal half of the femoropopliteal segment. The elastic properties of the femoropopliteal vessel are subject to marked variation along its course. To minimize compliance mismatch, the degree of elasticity engineered into a vascular graft must reflect that observed in vivo. (J Vasc Surg 1999;30:936-45.
Development of a discrete event simulation model for evaluating strategies of red blood cell provision following mass casualty events
No full textTimely and adequate provision of blood following mass casualty events (MCEs) is critical to reducing mortality rates amongst casualties transported to hospital following an event. Developing planning strategies to ensure the blood transfusion demands of casualties are met is challenging. Discrete event simulation (DES) offers a novel solution to this problem which is financially efficient, less disruptive to services and allows for rich experimentation compared to the current industry standards of live exercises, round-table discussion or tabletop planning. There are currently no published models of this type for investigating blood provision in MCEs. The objective of this study was to develop a working model which could be used to target the in-hospital 'levers' and 'supply levels' of the transfusion system and improve outcomes during the response to future events. This was achieved through the robust design of a DES model using exclusive access to qualitative and quantitative data as well as a panel of experts from the field of transfusion and MCE management. The completed model was extensively and formally evaluated with secondary data from the 7th of July 2005 London bombings, the largest UK based civilian MCE in over 50 years. A subsequent sensitivity analysis revealed the five factors displaying the greatest influence on casualty outcomes. Experimental themes based on these findings have generated new solutions for managing future events which have since been presented to MCE stakeholders and policy makers
