Prevocational integrated extended rural clinical experience (PIERCE): cutting through the barriers to prevocational rural medical education

Introduction: Despite an increase in the number of undergraduate training positions, Australia faces a critical shortage of medical practitioners in regional, rural and remote communities. Extended rural clinical placements have shown great utility in undergraduate medical curricula, increasing training capacity and providing comparable educational outcomes while promoting rural medicine as a career. The Prevocational Integrated Extended Rural Clinical Experience (PIERCE) was developed to increase the training capacity of the Queensland Rural Generalist Pathway (QRGP) and strengthen trainee commitment to rural practice by offering an authentic, extended 15-week rural term that provided an integrated experience in anaesthetics, obstetrics and gynaecology, and paediatrics, while meeting the requirements for satisfactory completion of prevocational rural generalist training. This study sought to evaluate whether trainees believed PIERCE and/or traditional regional hospital specialty placements achieved their learning objectives and to identify elements of the placements that contributed to, or were a barrier to, their realisation. Methods: This translational qualitative study explored the experiences and perceptions of QRGP trainees who undertook a PIERCE placement in three Queensland rural hospitals (Mareeba, Proserpine and Stanthorpe) in 2015, with a matched cohort of trainees who undertook regional hospital placements in anaesthetics, obstetrics and gynaecology, and paediatrics at a regional referral hospital (Cairns, Mackay and Toowoomba base hospitals). The study used a realist evaluation framework that investigates What works, for whom, in what circumstances, in what respects and why? Results: PIERCE provided an enjoyable and valued rural training experience that promoted trainee engagement with, and contribution to, a rural community of practice, reinforcing their commitment to a career in rural medicine. However, QRGP trainees did not accept that PIERCE could be a substitute for regional hospital experience in anaesthetics, obstetrics and gynaecology, and paediatrics. Rather, trainees thought PIERCE and regional hospital placements offered complementary experiences. PIERCE offered integrated, hands-on rural clinical experience in which trainees had more autonomy and responsibility. Regional hospital placements offered more traditional caseload learning experiences based on observation and the handing down of knowledge and skills by hospital-based supervisors. Conclusion: Both PIERCE and regional hospital placements provided opportunities and threats to the attainment of the curriculum objectives of the Australian Curriculum Framework for Junior Doctors, the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners Fellowship in Advanced Rural General Practice curricula. PIERCE trainees enjoyed the opportunity to experience rural medicine in a community setting, a broad caseload, hands-on proficiency, continuity of care and an authentic role as a valued member of the clinical team. This was reinforced by closer and more consistent clinical and educational interactions with their supervisors, and learning experiences that address key weaknesses identified in current hospital-based prevocational training. Successful achievement of prevocational curriculum objectives is contingent on strategic alignment of the curricula with supportive learning mechanisms focused by the learning context on the desired outcome, rural practice. This study adds weight to the growing consensus that rural community-based placements such as PIERCE are desirable components of prevocational training

NDM-552: COMBINED PROBABILITIES OF PEAK WIND AND SNOW LOAD EVENTS

The National Building Code of Canada 2010 (NBCC) defines several loading combination scenarios for use in structural design. Appropriate combination factors are provided based on the probability of failure due to the simultaneous occurrence of the specified loads. Load Combination Cases 3 and 4 of Table 4.1.3.2.A include the combination of wind and snow loads, which are transient in nature. The recommended combination factors are intended to provide a uniform degree of reliability for design. However, in reality, the probability of the simultaneous loading due to wind and snow depends on the local meteorological climate. This probability can be more accurately simulated through the Finite Area Element (FAE) process, which studies the hour-by-hour accumulation and depletion of snow based on historical meteorological records. It takes into account variables such as wind speed and direction, temperature, humidity, water retention in a snow pack and many others. In the present work, the accumulation and depletion of snow on a modelled ground patch and the corresponding wind speeds were computed on an hourly basis to determine the correlation of wind and snow loads. Using this process, this paper investigates the interaction between wind and snow loads for 25 distinct regions in Canada, for both ground and roof snow loads

STR-940: PARAMETRIC SIMULATION OF ROOF STRUCTURAL SNOW LOADS

While the National Building Code of Canada (NBCC) provides engineers with suitable snow loading guidelines for structural design, the strict application of the code may not lead to an optimized structural design. Generalizations have been made to ensure the applicability of the code to the majority of potential structures within Canada, which result in conservative estimates in certain situations. In particular, the interaction between region-specific prevailing wind directionality, climate and roof orientation are not accounted for. However, the development of advanced physical and numerical snow simulation approaches allows for the investigation of building-specific variables that affect snow loading. The Finite Area Element (FAE) process simulates the hour-by-hour accumulation and depletion of snow on a specific building design. This tool provides detailed quantification of the probabilistic snow loading accounting for region-specific long term meteorological conditions and building-specific variables such as roof size, exposure to prevailing winds, thermal capacity and local aerodynamics. While providing a detailed assessment of the snow loads, a full FAE assessment can be both time consuming and relatively costly for many applications. This parametric analysis approach has been developed using a variety of simple building geometries to provide an approach to assess the relative impacts of many of the key variables needed to inform a design. This paper describes the physical and numerical models used for the parametric simulation of snow loads, and discusses their application to structures within Canada

Soap operas and liberal education values

The purpose of this study was to examine college students' perceptions of the liberal education values mirrored in the actions and dialogue of the serials’ characters, to explore the artificial relationship viewers form with characters, and to identify any uses and gratifications satisfied by viewing. Five original hypotheses were tested concerning the relationship between amount of viewing time and artificial relationships, surveillance and reassurance, cognitive orientation, dissatisfaction, affective orientation, diversion, and liberal values score. Correlations between the independent and dependent variables and demographic variables (age, sex, marital status, ethnic background, income, major, and classification) were also examined

The Relationship between Physical Activity Variety and Objectively Measured Moderate-to-Vigorous Physical Activity Levels in Weight Loss Maintainers and Normal-Weight Individuals

Given the importance of physical activity (PA) for weight control, identifying strategies to achieve higher PA levels is imperative. We hypothesized that performing a greater variety of self-reported moderate-to-vigorous activities (MVPAs) would relate to higher objectively measured MVPA minutes in two groups who were successfully maintaining their body weight: weight loss maintainers (WLM/n = 226) and normal-weight individuals (NW/n = 169). The Paffenbarger Questionnaire and RT3 accelerometer were used to determine variety/number of different MVPAs performed and MVPA minutes, respectively. The variety/number of different activities performed by WLM and NW was similar (1.8 ± 1.2 versus 1.7 ± 1.2, P = 0.52). Regression analyses showed that greater variety (P < 0.01) and WLM status (P < 0.05) were each positively related to greater MVPA minutes/day and meeting the ≥250 MVPA minutes/week guideline for long-term weight maintenance. The association between greater variety and higher MVPA was similar in NW and WLM. Future studies should test whether variety can facilitate engagement in higher MVPA levels for more effective weight control

Individual differences in self-affirmation: distinguishing self-affirmation from positive self-regard

Research into self-affirmation has almost exclusively employed experimental manipulations. In this paper we address individual differences in the tendency to respond to threats with self-affirming cognitions and distinguish this from two overlapping constructs: habitual positive self-thought and trait self-esteem. Items we designed to measure self-affirmation were represented by three first-order factors and loaded on a higher-order factor, creating the Spontaneous Self-Affirmation Measure (SSAM). The SSAM correlated moderately with self-esteem and habitual positive self-thought. In competitive analyses, the SSAM was an independent predictor of a large number of outcomes. The studies provide evidence about the correlates of individual differences in reported spontaneous self-affirmation in response to threat and the contribution made to this response by habitual positive self-thought and trait self-esteem

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Census of Self-Obscured Massive Stars in Nearby Galaxies with Spitzer: Implications for Understanding the Progenitors of SN 2008S-Like Transients

A new link in the causal mapping between massive stars and potentially fatal explosive transients opened with the 2008 discovery of the dust-obscured progenitors of the luminous outbursts in NGC 6946 and NGC 300. Here we carry out a systematic mid-IR photometric search for massive, luminous, self-obscured stars in four nearby galaxies: M33, NGC 300, M81, and NGC 6946. For detection, we use only the 3.6 micron and 4.5 micron IRAC bands, as these can still be used for multi-epoch Spitzer surveys of nearby galaxies (=<10 Mpc). We combine familiar PSF and aperture-photometry with an innovative application of image subtraction to catalog the self-obscured massive stars in these galaxies. In particular, we verify that stars analogous to the progenitors of the NGC 6946 (SN 2008S) and NGC 300 transients are truly rare in all four galaxies: their number may be as low as ~1 per galaxy at any given moment. This result empirically supports the idea that the dust-enshrouded phase is a very short-lived phenomenon in the lives of many massive stars and that these objects constitute a natural extension of the AGB sequence. We also provide mid-IR catalogs of sources in NGC 300, M81, and NGC 6946.Comment: 21 pages, 15 figures, 11 tables. Accepted by ApJ on April 12, 2010. High resolution figures and full length versions of tables 6, 8 and 10 can be accessed at http://www.astronomy.ohio-state.edu/~khan/redstars