Appréhension ou évitement : l’expérience des résidents en médecine interne par rapport aux procédures invasives au chevet du patient

Background: Internal Medicine (IM) residents are required to perform bedside procedures for diagnostic and therapeutic purposes. Residents’ experiences with procedures vary widely, for unclear reasons. Objective: To explore IM residents’ experiences with performing bedside procedures and to identify barriers and facilitators to obtaining sufficient experience. Methods: Using an inductive, thematic approach, we conducted five individual semi-structured interviews and one focus group with seven IM residents (12 residents in total) during the 2017-2018 academic year at a Canadian tertiary care centre. We used iterative, open-ended questions to elicit residents’ experiences, and barriers and facilitators, to performing bedside procedures. Transcripts were analyzed for themes using Braun and Clarke’s method.  Results: We identified four themes 1) Patient-specific factors such as body habitus and procedure urgency; 2) Systems factors such as time constraints and accessibility of materials; 3) Faculty factors including availability to supervise, comfort level, and referral preferences, and 4) Resident-specific factors including preparation, prior experiences, and confidence. Some residents expressed procedure-related anxiety and avoidance. Conclusion: Educational interventions aimed to improve procedural efficiency and ensure availability of supervisors may help facilitate residents to perform procedures, yet may not address procedure-related anxiety. Further study is required to understand better how procedure-averse residents can gain confidence to seek out procedures.Contexte : Les résidents en médecine interne (MI) sont amenés à effectuer des procédures au chevet du patient à des fins diagnostiques et thérapeutiques. Les expériences des résidents par rapport à ces procédures varient considérablement, et nous ne savons pas pourquoi.Objectif : Explorer les expériences des résidents en médecine interne en matière d’interventions au chevet du patient et recenser les facteurs qui entravent ou, au contraire, facilitent l’acquisition d’une expérience suffisante.Méthodes : En utilisant une approche inductive et thématique, nous avons mené cinq entretiens individuels semi-structurés et un groupe de discussion avec sept résidents IM (12 résidents au total) dans un centre de soins tertiaires canadien au cours de l’année universitaire 2017-2018. Nous avons utilisé des questions ouvertes itératives pour interroger les résidents sur leur expérience d’intervention au chevet des patients, ainsi que sur les obstacles et les facilitateurs de ces interventions. Les transcriptions ont été analysées pour dégager des thèmes selon la méthode de Braun et Clarke. Résultats : Nous avons relevé quatre thèmes : 1) les facteurs spécifiques aux patients comme l’habitus corporel et l’urgence de l’intervention; 2) les facteurs systémiques comme les contraintes de temps et l’accès au matériel; 3) les facteurs liés aux enseignants, notamment leur disponibilité pour superviser, le fait d’être à l’aise avec eux et leurs préférences en matière de référence; et 4) les facteurs spécifiques aux résidents, à savoir la préparation, les expériences antérieures et la confiance. Certains résidents ont déclaré vivre de l’anxiété face aux procédures et les éviter.Conclusion : Les initiatives éducatives visant à améliorer l’efficacité des procédures et à assurer la disponibilité de superviseurs peuvent faciliter leur réalisation par les résidents, mais elles ne peuvent pas atténuer l’anxiété que ces interventions suscitent chez ces derniers. Des études supplémentaires sont nécessaires pour trouver des façons d’accroître la confiance des résidents qui sont réticents face aux interventions au chevet du patient

Anticipation or avoidance: internal medicine resident experiences performing invasive bedside procedures

Background: Internal Medicine (IM) residents are required to perform bedside procedures for diagnostic and therapeutic purposes. Residents’ experiences with procedures vary widely, for unclear reasons. Objective: To explore IM residents’ experiences with performing bedside procedures and to identify barriers and facilitators to obtaining sufficient experience. Methods: Using an inductive, thematic approach, we conducted five individual semi-structured interviews and one focus group with seven IM residents (12 residents in total) during the 2017-2018 academic year at a Canadian tertiary care centre. We used iterative, open-ended questions to elicit residents’ experiences, and barriers and facilitators, to performing bedside procedures. Transcripts were analyzed for themes using Braun and Clarke’s method.  Results: We identified four themes 1) Patient-specific factors such as body habitus and procedure urgency; 2) Systems factors such as time constraints and accessibility of materials; 3) Faculty factors including availability to supervise, comfort level, and referral preferences, and 4) Resident-specific factors including preparation, prior experiences, and confidence. Some residents expressed procedure-related anxiety and avoidance. Conclusion: Educational interventions aimed to improve procedural efficiency and ensure availability of supervisors may help facilitate residents to perform procedures, yet may not address procedure-related anxiety. Further study is required to understand better how procedure-averse residents can gain confidence to seek out procedures

Discover EDS: Tales of Implementation and Use

This paper supplements the panel, which was delivered in a “Lively Lunch” format and included presentations by librarians who have employed EBSCO’s Discovery System (EDS) in their academic institutions. The panelists addressed several important aspects of launching a discovery system in an academic library, such as Implementation; Information Literacy; and Assessment, Usability and Customization. The implementation component included technical aspects, business requirements, enhancing the operability of link resolvers, launch preparation, and implementation success. The information literacy portion addressed how academic reference services and library instruction have been transformed because of EDS. Assessment, Usability and Customization focused on customizing the search box and assessing EDS using statistics and usability testing. Michael Gorrell, Executive Vice President of Technology and Chief Information Officer of EBSCO Publishing, was present, and a Q&A time was scheduled at the end of each session for audience members to ask questions, comment, and share experiences. The implementation process of a Discovery Service involves many different aspects and is a large undertaking for any library. Depending on the size of the library, its technology infrastructure, and the number of staff involved, the implementation time can vary greatly. In addition, the planning processes and the considerations made prior to implementation are also affected by the nature and needs of end-users in these institutions. Selecting the resources to include in the discovery service, resolving technical issues, developing a strategy to publicize and market to end-users, and assessing and customizing the product are all part of a continuous course of implementing Discovery Services—a process that begins long before implementation and has no fixed completion. This process involves a collaborative and consorted effort from all areas of librarian expertise, from technical services to public services. The simplicity and comprehensiveness of discovery tools redefine how libraries deliver services across the board, changing the expectations users have of the experience of searching library resources and challenging librarians to redesign instruction and teach information literacy in new ways. These considerations and our own experience with implementing EBSCO’s Discovery System (EDS) at the University of South Florida prompted us to open up a discussion across university and college libraries in the U.S. and across librarian functions, technical, and public services, in order to share, discuss, and learn from each other the lessons of Discovery Service implementation and use. We wanted to focus on the continuous nature of this process, involving the user perspective, as well as the perspective of the vendor, EBSCO. We believe that talking with our colleagues and collaborating with publishers makes us much better positioned to anticipate the changing needs of users and enhance the experience, accessibility, and discoverability of library content

Altering adsorbed proteins or cellular gene expression in bone-metastatic cancer cells affects PTHrP and Gli2 without altering cell growth

AbstractThe contents of this data in brief are related to the article titled “Matrix Rigidity Regulates the Transition of Tumor Cells to a Bone-Destructive Phenotype through Integrin β3 and TGF-β Receptor Type II”. In this DIB we will present our supplemental data investigating Integrin expression, attachment of cells to various adhesion molecules, and changes in gene expression in multiple cancer cell lines. Since the interactions of Integrins with adsorbed matrix proteins are thought to affect the ability of cancer cells to interact with their underlying substrates, we examined the expression of Integrin β1, β3, and β5 in response to matrix rigidity. We found that only Iβ3 increased with increasing substrate modulus. While it was shown that fibronectin greatly affects the expression of tumor-produced factors associated with bone destruction (parathyroid hormone-related protein, PTHrP, and Gli2), poly-l-lysine, vitronectin and type I collagen were also analyzed as potential matrix proteins. Each of the proteins was independently adsorbed on both rigid and compliant polyurethane films which were subsequently used to culture cancer cells. Poly-l-lysine, vitronectin and type I collagen all had negligible effects on PTHrP or Gli2 expression, but fibronectin was shown to have a dose dependent effect. Finally, altering the expression of Iβ3 demonstrated that it is required for tumor cells to respond to the rigidity of the matrix, but does not affect other cell growth or viability. Together these data support the data presented in our manuscript to show that the rigidity of bone drives Integrinβ3/TGF-β crosstalk, leading to increased expression of Gli2 and PTHrP

Delayed Stellar Mass Assembly in the Low Surface Brightness Dwarf Galaxy KDG215

We present HI spectral line and optical broadband images of the nearby low surface brightness dwarf galaxy KDG215. The HI images, acquired with the Karl G. Jansky Very Large Array (VLA), reveal a dispersion dominated ISM with only weak signatures of coherent rotation. The HI gas reaches a peak mass surface density of 6 M$_{\odot}$ pc$^{-2}$ at the location of the peak surface brightness in the optical and the UV. Although KDG215 is gas-rich, the H$\alpha$ non-detection implies a very low current massive star formation rate. In order to investigate the recent evolution of this system, we have derived the recent and lifetime star formation histories from archival Hubble Space Telescope images. The recent star formation history shows a peak star formation rate $\sim$1 Gyr ago, followed by a decreasing star formation rate to the present day quiescent state. The cumulative star formation history indicates that a significant fraction of the stellar mass assembly in KDG215 has occurred within the last 1.25 Gyr. KDG215 is one of only a few known galaxies which demonstrates such a delayed star formation history. While the ancient stellar population (predominantly red giants) is prominent, the look-back time by which 50% of the mass of all stars ever formed had been created is among the youngest of any known galaxy.Comment: Accepted for publication in the Astrophysical Journal Letter

Electronic gaming machine characteristics: it's the little things that count

A range of gamblers, from low-frequency social gamblers through to problem gamblers in treatment, participated in focus groups discussing the characteristics of Electronic Gaming Machines (EGMs) that they found attractive. Analyses of the resulting transcripts resulted in two groups of EGM characteristics being identified as important, one group associated with winning and one with betting. Overall, free spin features were identified in all groups as the most attractive characteristic of EGMS. Beyond that it was smaller win-related characteristics, and low-denomination machines with multiple playable lines that were associated with increased duration and intensity of gambling behaviour. The important characteristics were consistent across different levels of gamblers, with the key behavioural difference being a self-reported ‘expertise’, and ‘strategic’ approach to gambling amongst higher-frequency gamblers and problem gamblers in treatment. The key characteristics all occur frequently and result in more wins and extended gambling sessions. The patterns identified resonated with established behavioural principles, and with models describing the development of problem gambling and addictions more generally

Volume 06

Introduction from Dean Dr. Charles Ross Caught Between Folklore and the Cold War: The Americanization of Russian Children\u27s Literature by Kristen Gains Graphic Design by Amanda Willis Graphic Design by Holly Backer Prejudices in Swiss German Accents by Monika Gutierrez Photography by Cara O\u27Neal Photography by Sara Nelson Edmund Tyrone\u27s Long Journey through Night by Sasha Silberman Photography by Jessica Beardsley Photography by Jamie Gardner and Edward Peeples The Republican Razor: The Guillotine as a Symbol of Equality by Jamie Clift Graphic Design by Matthew Sakach Genocide: The Lasting Effects of Gender Stratification in Rwanda By Tess Lione and Emily Wilkins Photography by Kelsey Holt and Jessica Page Morocco and the 20 February Movement by Charles Vancampen, Gilbert Hall, Jenny Nehrt, Kasey Dye, Amanda Tharp, Jamie Leeawrik, & Ashley McGee Photography by Emily Poulin Photography by Michael Kropf Improving Performance of Arbitrary Precision Arithmetic Using SIMD Assembly Code Instructions by Nick Pastore Art by Austin Polasky and Morgan Glasco Art by Laura L. Kahler The Effects of the Neutral Response Option on the Extremeness of Participant Responses by Melinda L. Edwards and Brandon C. Smith Graphic Design by Mariah Asbell Graphic Design by Cabell Edmunds College Bullying: An Exploratory Analysis by Amelia D. Perry Photography by Alyssa Hayes Death-Related Crime: Applying Bryant\u27s Conceptual Paradigm of Thanatological Crime to Military Settings by Irina Boothe Graphic Design by Perry Bason Graphic Design by James Earl

Gender Gap in Parental Leave Intentions: Evidence from 37 Countries

Despite global commitments and efforts, a gender-based division of paid and unpaid work persists. To identify how psychological factors, national policies, and the broader sociocultural context contribute to this inequality, we assessed parental-leave intentions in young adults (18–30 years old) planning to have children (N = 13,942; 8,880 identified as women; 5,062 identified as men) across 37 countries that varied in parental-leave policies and societal gender equality. In all countries, women intended to take longer leave than men. National parental-leave policies and women’s political representation partially explained cross-national variations in the gender gap. Gender gaps in leave intentions were paradoxically larger in countries with more gender-egalitarian parental-leave policies (i.e., longer leave available to both fathers and mothers). Interestingly, this cross-national variation in the gender gap was driven by cross-national variations in women’s (rather than men’s) leave intentions. Financially generous leave and gender-egalitarian policies (linked to men’s higher uptake in prior research) were not associated with leave intentions in men. Rather, men’s leave intentions were related to their individual gender attitudes. Leave intentions were inversely related to career ambitions. The potential for existing policies to foster gender equality in paid and unpaid work is discussed.Gender Gap in Parental Leave Intentions: Evidence from 37 CountriespublishedVersio