EP.TU.4Performance at Medical School predicts success in the Intercollegiate Membership of the Royal College of Surgery (MRCS) examination

Aims Identifying predictors of success in post-graduate examinations can help guide the career choices of medical students and may aid early identification of trainees requiring extra support to progress in specialty training. We assessed whether performance at medical school as quantified by the Educational Performance Measurement (EPM) and scores from the Situational Judgement Test (SJT) used for selection into Foundation Training predicted success at the Membership of the Royal College of Surgeons (MRCS) examination. Methods We analysed data from the UKMED Database for UK graduates who had attempted MRCS Part A (n = 1,975) and Part B n = 630) between 2013-2017. Univariate analysis examined the relationship between performance and the likelihood of passing MRCS at first-attempt. Logistic regression identified independent predictors of MRCS success. Results For every additional EPM decile point gained the chances of passing MRCS at first attempt increased by 52% for Part A (odds ratio 1.52 [95% confidence interval (CI) 1.46-1.60]) and 27% for Part B (1.27 [1.18-1.38]). For every point awarded for additional degrees in the EPM, candidates were 29% more likely to pass MRCS Part A first time (1.29 [1.12-1.48]). SJT score was not a statistically significant independent predictor of MRCS Part A or Part B success after adjusting for sociodemographic factors (P = 0.182 and P = 0.125 respectively). Conclusions This, the first study to investigate the relationship between medical school and success at a high stakes UK postgraduate surgical examination found that medical school performance deciles are the most significant measure of predicting later success in the MRCS.

Tracing One Warm Line: Climate Stories and Silences in Northwest Passage Tourism

This article examines representations of polar cruise tourism in the Northwest Passage as climate change extends the geographic range of open waters and increases the number of ice-free days in the Canadian Arctic. It connects current cruise promotion to earlier exploration histories and investigates the paradoxes that arise in the drive to bear witness to climate change while accelerating its impacts through carbon-intensive travel. It also examines some of the ways that Franklin expedition tourism in particular is being used to reinforce claims of Canadian sovereignty over Arctic resources. Overall, the promotion of this kind of maritime tourism highlights many of the key fault lines between visitor expectations and geophysical and cultural realities in a changing North, raising doubts about whether expanded development of such tourism can succeed in creating climate change ambassadors. The article concludes that the potential for developing cross-cultural environmental justice solidarities depends in significant measure on the tourism industry’s greater inclusion of Inuit perspectives that understand the Arctic not merely as a place to travel through, but as a homeland of earth, sea, and the shifting ice between.

Integration, Democracy, and Legitimacy

The first half of the chapter addresses the rich literature concerning the rationale for EU integration. The objective is to render accessible to lawyers, scholarship from international relations and political science that has explored the dynamic of EU integration. It is also designed to reveal the implications of particular theories for EU democracy. The focus in the second half of the chapter shifts to democracy itself, and analysis of the burgeoning literature concerned with the nature of EU democracy, the extent to which the EU suffers from a democratic deficit, and the ways in which it can be alleviated. There is a significant measure of agreement as to the problematic features within the EU from a democratic perspective. The scholarly divergence turns on differences as to the importance of different factors in assessing EU democracy, which leads to differences of view on aspects of the democratic deficit critique. The discussion will draw on insights from integration theory where relevant to the inquiry.

Does performance at medical school predict success at the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination? A retrospective cohort study

BackgroundIdentifying predictors of success in postgraduate examinations can help guide the career choices of medical students and may aid early identification of trainees requiring extra support to progress in specialty training. We assessed whether performance on the educational performance measurement (EPM) and situational judgement test (SJT) used for selection into foundation training predicted success at the Membership of the Royal College of Surgeons (MRCS) examination.MethodsThis was a longitudinal, cohort study using data from the UK Medical Education Database (https://www.ukmed.ac.uk). UK medical graduates who had attempted Part A (n=2585) and Part B (n=755) of the MRCS between 2014 and 2017 were included. χ2 and independent t-tests were used to examine the relationship between medical school performance and sociodemographic factors with first-attempt success at MRCS Part A and B. Multivariate logistic regression was employed to identify independent predictors of MRCS performance.ResultsThe odds of passing MRCS increased by 55% for Part A (OR 1.55 (95% CI 1.48 to 1.61)) and 23% for Part B (1.23 (1.14 to 1.32)) for every additional EPM decile point gained. For every point awarded for additional degrees in the EPM, candidates were 20% more likely to pass MRCS Part A (1.20 (1.13 to 1.29)) and 17% more likely to pass Part B (1.17 (1.04 to 1.33)). For every point awarded for publications in the EPM, candidates were 14% more likely to pass MRCS Part A (1.14 (1.01 to 1.28)). SJT score was not a statistically significant independent predictor of MRCS success.ConclusionThis study has demonstrated the EPM’s independent predictive power and found that medical school performance deciles are the most significant measure of predicting later success in the MRCS. These findings can be used by medical schools, training boards and workforce planners to inform evidence-based and contemporary selection and assessment strategies.

Efficacy of some medicated soaps and hand washes available in market

Background: Handwashing is underlined as the absolute most significant measure to forestall cross-transmission of small-scale life forms and consequently to forestall nosocomial contaminations. Be that as it may, under routine emergency clinic practice consistent with this measure is still unsatisfactorily low, under half in many investigations distributed in the previous 20 years. This consistent finding is stressing because ongoing investigations have demonstrated that this degree of consistency won't decrease the danger of transmission of multi- medicate safe microscopic organisms in the emergency clinics. Results: In the present investigation effect of marketed hand washed namely Lifebuoy, Dettol and Savlon were tested on bacteria E. coli, S.aureus, S.pyogen, Klebshiella and, fungi Candida albicans. All the handwash at concentrated level found to be effective but only Dettol hand wash could give inhibitory action at 25ug/ml against Klebshiella while others at50ug/ml. Conclusions: Soapex and Dettol soap had broad spectrum activity as it inhibited the growth of Gram positive (Streptococcus pyogen) and Gram-negative (Escherichia coli). Liquid handwash such as Lifebuoy,Dettol and Savlon showed broad spectrum activity on both Gram-positive and Gram negative test microorganisms.

Flood season segmentation and scheme optimization in the Yellow River

River flood season segmentation is a significant measure for flood prevention. This study aims to carry out theoretical analysis on flood season segmentation methods and put forward a framework for proper flood season segmentation through comparison between different segmentation methods. The studied framework consists of a Fisher optimal partition method for determining the optimum numbers of the sub-seasons, an ensemble approach for segmenting a defined flood season, and a nonparametric bootstrap combined with a fuzzy optimum selection method (NB-FOS) for testing the rationality of the flood season staging schemes. The present research findings show that different methods could result in different staging schemes. It is proved through rational analysis that the staging scheme obtained by probability change point (PCP) is superior to others. The flood season of the downstream reach of the Yellow River can be segmented into three sub-seasons, i.e. early flood season (01 June–20 July), main flood season (21 July–28 September), and late flood season (29 September–08 November). The segmentation results of the flood season should play an active role in flood prevention.

An Investigation into Residents' Willingness to Pay for Vertical Greening in the Renovation of Existing Residential Areas for Greenhouse Gases Reduction- A Case Study of Hangzhou City

There are numerous buildings in existing residential areas in Hangzhou City, which results in much carbon emissions and the formation of greenhouse gases that have exerted significant ad-verse impacts on the living comfort of citizens in Hangzhou City. It is imperative to conduct a greening renovation of buildings in existing residential areas in Hangzhou City. Vertical greening, as a significant measure of renovation, has received much attention. In this paper we use double-bounded discrete choice format to elicit public’s willingness to pay (WTP), and the economic benefits of vertical greening reduces greenhouse gases in Hangzhou City were preliminarily estimated, and the factors that affect residents' payment and participation. A total of 1089 valid samples were obtained via the face-to-face field interview. There were 250 (23.0%) respondents who refused to pay, whose data were subject to processing with Spike model, which had been proved to be more advantageous than traditional models in dealing with zero response problems. Families in Hangzhou City would pay 702.55 Chinese yuan (CNY) each year. The economic benefit of the project is 1.141–1.433 billion CNY. The factors affecting WTP were explored by demographic characteristics,social psychology༌knowledge of the environment and theory of planned behavior. The results showed that there were obvious statistical relationships between the age, income, family members, cognition of vertical greening and subjective norms of respondents and their WTP. Meanwhile, the feedback information was collected and analyzed, with the results showing that increasing income, setting up compensation mechanism, promoting the publicity of environmental protection, and disclosing the flow of funds would conduce to residents' participation in the renovation of vertical greening.

Comprehensive analysis of carbon emissions, economic growth, and employment from the perspective of industrial restructuring: a case study of China

Industrial restructuring is a significant measure for low-carbon transition. In principle, carbon emissions can be effectively reduced by limiting the output of high-emission sectors; however, the socio-economic effects of the sectors should also be considered. Moreover, owing to the limitations of the method or data, the interactions between households and production sectors have been neglected in the study of industrial restructuring, resulting in an incomplete and potentially biased understanding of the role of households. To fill this gap, we applied a semi-closed input–output model to identify key sectors by economic and emission linkages and measure the employment impacts (direct, indirect, and induced) of reduced carbon emissions. The empirical results for China in 2010–2018 showed that relatively small changes in key emission sectors would significantly affect the economic growth, and reduced carbon emissions reduction would generally lead to high job losses. Promoting labor-intensive sectors, particularly the service sector, is conducive to achieving a “multi-win” situation for economic development, carbon emission reductions, and stable employment. Furthermore, our results highlight the significance of households: expanding consumption and increasing household income can bring multiple benefits, such as economic growth, job creation, and low carbon emissions. These findings can provide useful information for identifying the optimized path of restructuring and helping achieve the sustainable development of the environment, economy, and society.

432 Brain Structure and Baroreflex Sensitivity Associations in Obstructive Sleep Apnea with and without CPAP

Introduction Obstructive sleep apnea (OSA) disrupts multiple aspects of autonomic regulation; it is unclear whether intervention with continuous positive airway pressure (CPAP) can correct such disruptions. One key index of autonomic regulation is baroreflex sensitivity (BRS), an index that indicates heart rate (HR) changes to blood pressure (BP) alterations, and which is a significant measure for evaluating long-term cardiovascular changes induced by OSA. BRS can be assessed from BP and HR changes during an autonomic challenge task such as handgrip (HG). In a cross-sectional study, we assessed BRS during HG in untreated OSA (OSA_un) and CPAP treated OSA (CPAP), together with healthy control (CON) participants to determine if CPAP can recover BRS. Methods We collected ECG and continuous beat-by-beat BP from 95 people: 32 newly-diagnosed OSA_un (51.5±13.9years; AHI 21.0±15.3events/hour; 20male); 31 CPAP (49.4±14.0years; 22.4±14.1events/hour in initial diagnosis; 23male); and 32 CON (44.1±13.8years; 10male). We acquired data over 7 mins, during which people performed three 30s HGs (60 s baseline, 90 s recovery, 80% maximum strength). We calculated BRS over the 7 min period using sequence analysis in AcqKnowledge 5.0 BRS, followed by group comparisons using ANOVA. We also analyzed BP, HR, and their variabilities: BPV and HRV (sympathetic-vagal). Results Mean arterial BP increases during HG were similar in all groups, although baseline mean arterial BP was higher in OSA_unc and CPAP, relative to CON (p < 0.05; OSA_un:mean±std, 90±11mmHg; CPAP: 88±10mmHg; CON 82±13mmHg). BRS was lower in OSA_un and CPAP, relative to CON (p < 0.05; OSA_un: 13.1±7.6 ms/mmHg; CPAP: 13.7±9.0 ms/mmHg; control 18.3±11.9 ms/mmHg). Other cardiovascular measures of BPV, HR, and HRV in addition to BP showed significant increases in response to HG, but these changes were similar in all 3 groups. Conclusion BRS during HG was reduced in both OSA_un and CPAP compared to CON, while HG evoked similar overall changes in BP and HR in all three groups. Although CPAP reduces sympathetic tone measured as Muscle Sympathetic Nerve Activity (MSNA), BRS appears to be unaffected by the intervention. Irreversible changes in the baroreflex network may occur with OSA that are not altered with CPAP usage. Support (if any) NR-017435, HL135562

428 Baroreflex sensitivity during handgrip in obstructive sleep apnea with and without CPAP

Introduction Obstructive sleep apnea (OSA) disrupts multiple aspect of autonomic regulation; it is unclear whether intervention with continuous positive airway pressure (CPAP) can correct such disruptions. One key index of autonomic regulation is baroreflex sensitivity (BRS), an index that indicates heart rate (HR) changes to blood pressure (BP) alterations, and which is a significant measure for evaluating long-term cardiovascular changes induced by OSA. BRS can be assessed from BP and HR changes during an autonomic challenge task such as handgrip (HG). In a cross-sectional study, we assessed BRS during HG in untreated OSA (OSA_un) and CPAP treated OSA (CPAP), together with healthy control (CON) participants to determine if CPAP can recover BRS. Methods We collected ECG and continuous beat-by-beat BP from 95 people: 32 newly-diagnosed OSA_un (51.5±13.9years; AHI 21.0±15.3events/hour; 20male); 31 CPAP (49.4±14.0years; 22.4±14.1events/hour in initial diagnosis; 23male); and 32 CON (44.1±13.8years; 10male). We acquired data over 7 mins, during which people performed three 30s HGs (60 s baseline, 90 s recovery, 80% maximum strength). We calculated BRS over the 7 min period using sequence analysis in AcqKnowledge 5.0 BRS, followed by group comparisons using ANOVA. We also analyzed BP, HR and their variabilities: BPV and HRV (sympathetic-vagal). Results Mean arterial BP increases during HG were similar in all groups, although baseline mean arterial BP was higher in OSA_unc and CPAP, relative to CON (p < 0.05; OSA_un:mean±std, 90±11mmHg; CPAP: 88±10mmHg; CON 82±13mmHg). BRS was lower in OSA_un and CPAP, relative to CON (p < 0.05; OSA_un: 13.1±7.6 ms/mmHg; CPAP: 13.7±9.0 ms/mmHg; control 18.3±11.9 ms/mmHg). Other cardiovascular measures of BPV, HR and HRV in addition to BP showed significant increases in response to HG, but these changes were similar in all 3 groups. Conclusion BRS during HG was reduced in both OSA_un and CPAP compared to CON, while HG evoked similar overall changes in BP and HR in all three groups. Although CPAP reduces sympathetic tone measured as Muscle Sympathetic Nerve Activity (MSNA), BRS appears to be unaffected by the intervention. Irreversible changes in the baroreflex network may occur with OSA that are not altered with CPAP usage. Support (if any) NR-017435, HL135562