Biochar application modified growth and physiological parameters of Ocimum ciliatum L. and reduced human risk assessment under cadmium stress.

Biochar (BC) is prepared from waste organic material that can improve soil health in the contaminated area. Soil pollution with cadmium (Cd) is one of the worldwide problems. The present study aimed to evaluate the BC influence on some morphophysiological and biochemical characteristics, also Cd concentration of Ocimum ciliatum L. leaves under Cd stress as well as human risk assessment. Therefore, a pot factorial arrangement based on a completely randomized design was done which included three levels of BC (non-BC, 1%, and 2% of the pot soil) and three Cd levels (0, 20, and 40 mg/kg soil) with three replications. The results of the present study indicated that BC application improved morphological traits, photosynthetic pigments, relative water content (RWC), and catalase (CAT) activity of O. ciliatum under Cd stress and reduced total soluble sugars, total phenol, antioxidant activity, proline content, electrolyte leakage (EL), soluble protein content, ascorbate peroxidase (APX), and guaiacol peroxidase (GPX) activities, and Cd concentration as well as target hazard quotient (THQ). In conclusion, based on the findings of this study, BC could be applied as an environmental friendly amendment in Cd-polluted soil to ameliorate the negative influences of Cd stress on O. ciliatum and reduces Cd levels and THQ in the plants due to the absorption properties of BC. This means that BC usage in contaminated soil helps to reduce pollutions and decreases the human risk assessment.

Phytotoxicity and antifungal properties of the essential oil from the Juniperus polycarpos var. turcomanica (B. Fedsch.) R.P. Adams leaves.

This study was performed to investigate the constituents, in vitro antifungal activity and phytotoxicity potential of the essential oil from Juniperus polycarpos var. turcomanica leaves. The essential oil was analyzed by GC-FID, and GC/MS, which predominantly contains α-pinene (51.21%), germacrene-B (4.80%), and ∆-cadinene (2.56%). The antifungal activity of the essential oil against some phytopathogenic fungi, including Alternaria alternata, Colletotrichum trichellum, Curvularia fallax, Cytospora sacchari, Fusarium oxysporum, and Macrophomina phaseolina was performed through disk diffusion and agar dilution assays. The essential oil of J. polycarpos var. turcomanica had high antifungal activity against tested phytopathogenic fungi. The most susceptible fungi to the essential oil were C. trichellum in agar dilution and M. phaseolina and C. fallax in disk diffusion methods, whereas, the most resistant fungus to the essential oil was obtained from A. alternata in both assays. Screening methods had an influence on antifungal activity of the essential oil as most of the tested fungi in this study were shown to be more resistant in disc diffusion methods. According to the phytotoxic assay results, the essential oil from J. polycarpos var. turcomanica had high phytotoxicity against three species of weeds, including P. oleracea L., A. retroflexus L., and D. stramonium L. The results of this research suggest that the herbicidal and antifungal activities of the essential oil from J. polycarpos var. turcomanica can be attributed to its major group of constituents, monoterpenes hydrocarbons.

Macro- and microelement content and health risk assessment of heavy metals in various herbs of Iran.

In this study, element content and health risk of the most popular herbs from Iran were evaluated. The samples of raw materials from 30 different herbs were purchased from the local markets of Iran. The concentration levels of some elements including macroelements (N, P, K, Ca, and Mg), micronutrients (Fe, Zn, Cu, Mn, and Na), and heavy metals (Cd, Ni, and Pb) of studied herbs were evaluated. The potential of health risks was calculated by Estimated Daily Intake (EDI), Target Hazard Quotient (THQ), and Hazard Index (HI). The analysis of variance (ANOVA) is used to test a hypothesis about differences between the mean values. The highest levels of Ca (20,000 ± 26.3 mg/kg), Mg (9600 ± 45.4 mg/kg), N (59,955 ± 11.55 mg/kg), P (6544 ± 20 mg/kg), and K (56,563.2 ± 18 mg/kg) were found in Zataria multiflora, Malva sylvestris, Acasia arbus, Cannabis sativa, and Amomum subulatum, respectively. In addition, the highest concentration levels of Fe (987 ± 75.27 mg/kg), Zn (1187.5 ± 10 mg/kg), Cu (64.2 ± 2 mg/kg), Mn (272.3 ± 66.62 mg/kg), and Na (2658.8 ± 20.3 mg/kg) were recorded in Bunium persicum, Peganum harmala, Papaver somniferum, Alpinia officinalis, and Cuminum cyminum, respectively. Acasia arbus, Anethum graveolens, and Malva sylvestris showed the highest concentration of Ni (6.07 ± 0.04 mg/kg), Cd (1.64 ± 0.16 mg/kg), and Pb (9.27 ± 0.25 mg/kg). Based on performed health risk assessment on the studied plants, EDI, THQ, and HI values of all of them were less than 1. This study indicated that there were several harmful elements in the herbs. The healthier plant species are those with the least concentration of Pb, Ni, and Cd, which include Vitex agnus-custus and Teucrium polium. On the other hand, the toxic plants with a higher concentration of Pb, Ni, and Cd included Malva sylvestris, Acasia arbus, and Anethum graveolens. In addition, evaluation of human risk assessment is an important factor for investigating the concentration of heavy metals harmful for human beings.

Realist evaluation of UK medical education quality assurance.

OBJECTIVES: The aim of the study was to explore what components of the General Medical Council's (GMC) Quality Assurance Framework work, for whom, in what circumstances and how? SETTING: UK undergraduate and postgraduate medical education and training. PARTICIPANTS: We conducted interviews with a stratified sample of 36 individuals. This included those who had direct experiences, as well as those with external insights, representing local, national and international organisations within and outside medicine. INTERVENTION: The GMC quality assure education to protect patient and public safety utilising complex intervention components including meeting standards, institutional visits and monitoring performance. However, the context in which these are implemented matters. We undertook an innovative realist evaluation to test an initial programme theory. Data were analysed using framework analysis. RESULTS: Across components of the intervention, we identified key mechanisms, including transparent reporting to promote quality improvement; dialogical feedback; partnership working facilitating interactions between regulators and providers, and role clarity in conducting proportionate interventions appropriate to risk. The GMC's framework was commended for being comprehensive and enabling a broad understanding of an organisation's performance. Unintended consequences included confusion over roles and boundaries in different contexts which often undermined effectiveness. CONCLUSIONS: This realist evaluation substantiates the literature and reveals deeper understandings about quality assuring medical education. While standardised approaches are implemented, interventions need to be contextually proportionate. Routine communication is beneficial to verify data, share concerns and check risk; however, ongoing partnership working can foster assurance. The study provides a modified programme theory to explicate how education providers and regulators can work more effectively together to uphold education quality, and ultimately protect public safety. The findings have influenced the GMC's approach to quality assurance which impacts on all medical students and doctors in training.

The GP tests of competence assessment: which part best predicts fitness to practise decisions?

BACKGROUND: The General Medical Council (GMC) conducts Tests of Competence (ToC) for doctors referred for Fitness to Practise (FtP) issues. GPs take a single best answer knowledge test, an Objective Structured Clinical Examination (OSCE), and a Simulated Surgery (SimSurg) assessment which is a simulated GP consultation. The aim of this study was to examine the similarities between OSCEs and SimSurg to determine whether each assessment contributed something unique to GP ToCs. METHODS: A mixed methods approach was used. Data were collated on 153 GPs who were required to undertake a ToC as a part of being investigated for FtP issues between February 2010 and October 2016. Using correlation analysis, we examined to what degree performance on the knowledge test, OSCE, and SimSurg related to case examiner recommendations and FtP outcomes, including the unique predictive power of these three assessments. The outcome measures were case examiner recommendations (i) not fit to practise; ii) fit to practise on a limited basis; or iii) fit to practise) as well as FtP outcomes (i) erased/removed from the register; ii) having restrictions/conditions; or iii) be in good standing). For the qualitative component, 45 GP assessors were asked to rate whether they assess the same competencies and which assessment provides better feedback about candidates. RESULTS: There was significant overlap between OSCEs and SimSurg, p < 0.001. SimSurg had additional predictive power in the presence of OSCEs and the knowledge test (p = 0.030) in distinguishing doctors from different FtP categories, while OSCEs did not (p = 0.080). Both the OSCEs (p = 0.004) and SimSurg (p < 0.001) had significant negative correlations with case examiner recommendations when accounting for the effects of the other two assessments. Inductive thematic analysis of the responses to the questionnaire showed that assessors perceived OSCEs to be better suited to target specific knowledge and skills. SimSurg was thought to produce a more global picture as the scenarios more accurately portray a patient consultation. CONCLUSION: While all three assessments are strong predictors of both case examiner recommendations and FtP outcomes, our findings suggest that the efficiency of GP ToCs can be improved by removing some of this overlapping content.

Are the General Medical Council's Tests of Competence fair to long standing doctors? A retrospective cohort study.

BACKGROUND: The General Medical Council's Fitness to Practise investigations may involve a test of competence for doctors with performance concerns. Concern has been raised about the suitability of the test format for doctors who qualified before the introduction of Single Best Answer and Objective Structured Clinical Examination assessments, both of which form the test of competence. This study explored whether the examination formats used in the tests of competence are fair to long standing doctors who have undergone fitness to practise investigation. METHODS: A retrospective cohort design was used to determine an association between year of primary medical qualification and doctors' test of competence performance. Performance of 95 general practitioners under investigation was compared with a group of 376 volunteer doctors. We analysed performance on knowledge test, OSCE overall, and three individual OSCE stations using Spearman's correlation and regression models. RESULTS: Doctors under investigation performed worse on all test outcomes compared to the comparison group. Qualification year correlated positively with performance on all outcomes except for physical examination (e.g. knowledge test r = 0.48, p < 0.001 and OSCE r = 0.37, p < 0.001). Qualification year was associated with test performance in doctors under investigation even when controlling for sex, ethnicity and qualification region. Regression analyses showed that qualification year was associated with knowledge test, OSCE and communication skills performance of doctors under investigation when other variables were controlled for. Among volunteer doctors this was not the case and their performance was more strongly related to where they qualified and their ethnic background. Furthermore, volunteer doctors who qualified before the introduction of Single Best Answer and OSCE assessments, still outperformed their peers under investigation. CONCLUSIONS: Earlier graduates under fitness to practise investigation performed less well on the test of competence than their more recently qualified peers under investigation. The performance of the comparator group tended to stay consistent irrespective of year qualified. Our results suggest that the test format does not disadvantage early qualified doctors. We discuss findings in relation to the GMC's fitness to practise procedures and suggest alternative explanations for the poorer performance of long standing doctors under investigation.

Doctors who pilot the GMC's Tests of Competence: who volunteers and why?

BACKGROUND: Doctors who are investigated by the General Medical Council for performance concerns may be required to take a Test of Competence (ToC). The tests are piloted on volunteer doctors before they are used in Fitness to Practise (FtP) investigations. OBJECTIVES: To find out who volunteers to take a pilot ToC and why. METHODS: This was a retrospective cohort study. Between February 2011 and October 2012 we asked doctors who volunteered for a test to complete a questionnaire about their reasons for volunteering and recruitment. We analysed the data using descriptive statistics and Pearson's χ(2) test. RESULTS: 301 doctors completed the questionnaire. Doctors who took a ToC voluntarily were mostly women, of white ethnicity, of junior grades, working in general practice and who held a Primary Medical Qualification (PMQ) from the UK. This was a different population to doctors under investigation and all registered doctors in the UK. Most volunteers heard about the General Medical Council's pilot events through email from a colleague and used the experience to gain exam practice for forthcoming postgraduate exams. CONCLUSIONS: The reference groups of volunteers are not representative of doctors under FtP investigation. Our findings will be used to inform future recruitment strategies with the aim to encourage better matching of groups who voluntarily pilot a ToC with those under FtP investigation.

How well do doctors think they perform on the General Medical Council's Tests of Competence pilot examinations? A cross-sectional study.

OBJECTIVE: To investigate how accurately doctors estimated their performance on the General Medical Council's Tests of Competence pilot examinations. DESIGN: A cross-sectional survey design using a questionnaire method. SETTING: University College London Medical School. PARTICIPANTS: 524 medical doctors working in a range of clinical specialties between foundation year two and consultant level. MAIN OUTCOME MEASURES: Estimated and actual total scores on a knowledge test and Observed Structured Clinical Examination (OSCE). RESULTS: The pattern of results for OSCE performance differed from the results for knowledge test performance. The majority of doctors significantly underestimated their OSCE performance. Whereas estimated knowledge test performance differed between high and low performers. Those who did particularly well significantly underestimated their knowledge test performance (t (196)=-7.70, p<0.01) and those who did less well significantly overestimated (t (172)=6.09, p<0.01). There were also significant differences between estimated and/or actual performance by gender, ethnicity and region of Primary Medical Qualification. CONCLUSIONS: Doctors were more accurate in predicating their knowledge test performance than their OSCE performance. The association between estimated and actual knowledge test performance supports the established differences between high and low performers described in the behavioural sciences literature. This was not the case for the OSCE. The implications of the results to the revalidation process are discussed.