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The Tongue Drive System (TDS) is a wireless and wearable assistive technology, designed to allow individuals with severe motor impairments such as tetraplegia to access their environment using voluntary tongue motion. Previous TDS trials used a magnetic tracer temporarily attached to the top surface of the tongue with tissue adhesive. We investigated TDS efficacy for controlling a computer and driving a powered wheelchair in two groups of able-bodied subjects and a group of volunteers with spinal cord injury (SCI) at C6 or above. All participants received a magnetic tongue barbell and used the TDS for five to six consecutive sessions. The performance of the group was compared for TDS versus keypad and TDS versus a sip-and-puff device (SnP) using accepted measures of speed and accuracy. All performance measures improved over the course of the trial. The gap between keypad and TDS performance narrowed for able-bodied subjects. Despite participants with SCI already having familiarity with the SnP, their performance measures were up to three times better with the TDS than with the SnP and continued to improve. TDS flexibility and the inherent characteristics of the human tongue enabled individuals with high-level motor impairments to access computers and drive wheelchairs at speeds that were faster than traditional assistive technologies but with comparable accuracy.

Cardiac beriberi is considered a rare disease in western society. A patient with fulminant Shoshin-type beriberi was studied in the acute phase and found to have severe metabolic acidosis, high output biventricular failure, and markedly low systemic vascular resistance. Red blood cell transketolase activity was abnormally low. Following treatment with thiamine, diuretics, digitalis and oxygen, all abnormalities disappeared. The historical background of the disease is reviewed along with a discussion of pathophysiologic mechanisms responsible for the hemodynamic profile and lactic acidosis. Angiographic and hemodynamic data on the patient presented suggest relative depression of left ventricular function in the acute phase of beriberi. Since beriberi is uncommonly encountered, emphasis is placed on diagnostic and therapeutic implications of the disease which may not be widely appreciated.

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-A pilot of core medical training (CMT) was conducted in 2006-7 with 160 trainees and 130 supervisors in the 10 hospitals within the Mersey Deanery. Questionnaires and focus groups were used to gain feedback from trainees and supervisors in relation to the components of CMT (the curricula, workplace-based assessments, appraisal, and the e-portfolio). There was generally a positive attitude to the CMT package. In particular the opportunities to give and receive feedback were appreciated; the e-portfolio was identified as helpful for recording assessment outcomes and supporting educational development for the trainees. The workplace-based assessments were well received. Many of the benefits of the components of CMT depended on the skill of the supervisor. The time required for effective training supervision and workplace-based assessments was identified as an important issue. This pilot was invaluable in informing the widespread implementation of CMT in 2007. KEY WORDS: curricula, postgraduate assessment, postgraduate training IntroductionThis study aims to demonstrate the components of the core medical training (CMT) programme, and describe the pilot that was conducted to inform its widespread launch. The Federation of Royal Colleges of Physicians has produced two medical curricula for early postgraduate training. The general internal medicine (acute) (GIM(A)) and generic curricula have been approved by the Postgraduate Medical Education and Training Board (PMETB). The GIM(A) curriculum defines the knowledge, skills and attitudes that trainees successfully completing a CMT programme must acquire before proceeding into further training in any of the physicianly specialties. The generic curriculum defines the competencies that must be acquired by the end of specialist training to facilitate clinical practice on a sound moral, legal, ethical and professional framework.The Mersey Deanery School of Medicine (MDSM) and the Federation of the Royal Colleges of Physicians collaborated to conduct a pilot of CMT from August 2006 to August 2007. The new curricula and an electronic (e) portfolio were used by 160 trainees and 130 supervisors in this deanery. This paper describes the methods of using feedback from trainees and supervisors to evaluate the effectiveness of the CMT package (curricula, appraisal, assessment and the e-portfolio), and reports the results and conclusions that have informed the nationwide launch of the CMT programme. MethodsAll trainees attended a session introducing the CMT package soon after assuming their posts in the MDSM CMT rotation in August 2006. All supervisors were invited to attend one of several training days introducing the CMT package. Feedback from trainees and supervisors was gathered using separate focus groups, and on-line questionnaires. The data gathering was scheduled to coincide with the end of the trainees' four-month attachments (end of November, March and July), and is summarised in Fig 1. E-portfolio usage statistics were also analysed as part of the evaluation.Feedba...