Failure of an Educational Intervention to Improve Consultation and Implications for Healthcare Consultation.

INTRODUCTION: Consultation of another physician for his or her specialized expertise regarding a patient's care is a common occurrence in most physicians' daily practice, especially in the emergency department (ED). Therefore, the ability to communicate effectively with another physician during a patient consultation is an essential skill. However, there has been limited research on a standardized method for a physician to physician consultation with little guidance on teaching consultations to physicians in training. The objective of our study was to measure the effect of a structured consultation intervention on both content standardization and quality of medical student consultations. METHODS: Senior medical students were assessed on a required emergency medicine rotation with a physician phone consultation during a standardized, simulated chest pain case. The intervention groups received a standard consult checklist as part of their orientation to the rotation, followed by a video recording of a good consult call and a bad consult call with commentary from an emergency physician. The intervention was given to students every other month, alternating with a control group who received no additional education. Recordings were reviewed by three second-year internal medicine residents pursuing a fellowship in cardiology. Each recording was evaluated by two of the three reviewers and scored using a standardized checklist. RESULTS: Providing a standardized consultation intervention did not improve students' ability to communicate with consultants. In addition, there was variability between evaluators in regards to how they received the same information and how they perceived the quality of the same recorded consultation calls. Evaluator inter-rater reliability (IRR) was poor on the questions of 1) would you have any other questions of the student calling the consult and 2) did the student calling the consult provide an accurate account of information and case detail. The IRR was also poor on objective data such as whether the student stated their name. CONCLUSIONS: A brief intervention may not be enough to change complex behavior such as a physician to physician consultant communication. Importantly, despite consultants listening to the same audio recordings, the information was processed differently. Future investigations should focus on both those delivering as well as those receiving a consultation

A study of SecA : the motor of the bacterial secretion system by site-directed spin labeling and EPR

The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file.Title from title screen of research.pdf file (viewed on August 28, 2008)Vita.Thesis (M.S.) University of Missouri-Columbia 2008.For more than 3 decades, the biochemical details of the Sec system of protein export have been teased out of Escherichia coli. Through these efforts we know that SecA, the ATPase of the Sec system, interacts with several entities: unfolded precursor polypeptides, the molecular chaperone SecB, membrane phospholipids, and the membrane-embedded translocase SecYEG. Functional studies implied that some of these interactions occurred simultaneously. However, little is known about the details of these binding sites, and it was not clear to what extent SecA interacted with these diverse ligands at distinct, adjacent or overlapping surfaces along its extended structure. We investigated these issues using electron paramagnetic resonance (EPR) spectroscopy and site-directed spin labels at a multitude of sites on the surface of the 102 kDa SecA protein. EPR spectroscopy is sensitive to changes in the local environment of the spin label, and thus our survey of the SecA surface provided a map of interaction sites with its partners in the Sec pathway of protein export. Strikingly, we found that SecA utilizes a single interactive surface to bind its multiple partners during protein export. Knowing the locations and relationships of these binding sites on the surface of SecA represents significant progress in revealing the mechanistic steps of passing an unfolded polypeptide chain from SecB to SecA and ultimately driving it through the secretion pore.Includes bibliographical reference

Factors that Contribute to Resident Teaching Effectiveness

Background One of the key components of residency training is to become an educator. Resident physicians teach students, advanced practice providers, nurses, and even faculty on a daily basis. Objective The goal of this study was to identify the objective characteristics of residents, which correlate with perceived overall teaching effectiveness. Methods We conducted a one-year, retrospective study to identify factors that were associated with higher resident teaching evaluations. Senior emergency medicine (EM) teaching residents are evaluated by medical students following clinical teaching shifts. Eighteen factors pertaining to resident teaching effectiveness were chosen. Two items from the medical students' evaluations were analyzed against each factor: teaching effectiveness was measured on a five-point Likert scale and an overall teaching score (1-75). Results A total of 46 EM residents and 843 medical student evaluations were analyzed. The ACGME milestones for systems-based practice (p = 0.02) and accountability (p = 0.05) showed a statistically significant association with a rating of "five" on the Likert scale for teaching effectiveness. Three other ACGME milestones, systems-based practice (p = 0.01), task switching (p = 0.04), and team management (p = 0.03) also showed a statically significant association of receiving a score of 70 or greater on the overall teaching score. Conclusion Residents with higher performance associated with system management and accountability were perceived as highly effective teachers. USMLE and in-service exams were not predictive of higher teaching evaluations. Our data also suggest that effective teachers are working in both academic and community settings, providing a potential resource to academic departments and institutions

Anomalously large marine potholes on a submerged relict shore platform: The Eastern Cape shelf of SE Africa

Marine potholes are common features along rocky shore platforms from around the world. Their occurrence can be used as a palaeo-sea level indicator, however, little attention has been given to submerged marine potholes found on relict shore platforms below the depth limits of SCUBA (≤50 m). This paper examines (n = 238) anomalously large potholes found on a submerged aeolianite shore platform on the outer shelf of the Eastern Cape, South Africa. Using a combined ultra-high resolution seismic reflection, side scan sonar and multibeam bathymetry approach, together with remote observation vehicle dives, the pothole occurrences are mapped.Potholes are either individual or occasionally conjoined, form on sediment-free aeolianite platform and cluster mostly between water depths of 85–95 m. Their sizes are an order of magnitude larger than previously documented, and larger than their fluvial equivalents. Pothole strings are common, associated with the high points between NNW-SSE striking bedding planes of the aeolianite that crop out at the seabed. Potholes are often elongated and aligned with these bedding planes, or in a coast parallel fashion, associated with joints and micro-cliffs in the aeolianite.The potholes possibly formed during several slowstands or stillstands surrounding the Last Glacial Maximum (LGM, 25,000 to 20,000 yr BP) and the Bølling-Allerød interstadial (B-A, 14,500 yr BP). Given their sizes, we ascribe part of their development to chemical weathering of the platform, especially during the periods where sea spray could pond to form dissolution pans in the supratidal part of the aeolianite platform. A wet and warm B-A climate exacerbated chemical weathering, with karst processes initially dominant, followed by mechanical weathering with shoreline migration. Once submerged, only horizontal enlargement ensued. Geological contingencies (joints, bedding planes and platform lowpoints), modified by early weathering-dominant and later wave-dominant processes, were responsible for the evolution of the shore platform morphology

Preventing and improving interactions between autistic individuals and the criminal justice system: A roadmap for research

Researchers have identified that autistic individuals are encountering the criminal justice system as victims, offenders, and witnesses at high rates. The prevalence of autism spectrum disorder (ASD) is increasing and generating a comprehensive approach to addressing criminal justice system involvement among autistic individuals is a timely and urgent need. Revisions to an established framework generated for use among individuals with mental health diagnoses, the sequential Intercept Model (SIM), were produced by an international consortium of interdisciplinary stakeholders presenting a new opportunity to identify gaps in ASD research and generate preventive solutions across the criminal justice system. The revised SIM maps each criminal justice system component, or Intercept, and includes paths for the experiences of autistic individuals as victims or witnesses to crimes as well as offenders to catalyze new and interdisciplinary research, policy, and practice efforts. As the field of ASD research continues to grow, the revised SIM is a promising pathway to avoiding siloed research approaches, including diverse autistic voices, and contributing to international dialogue about criminal justice reform at a critical juncture. LAY SUMMARY: Autistic individuals are encountering the criminal justice system as victims, offenders, and witnesses at high rates. A revised version of the SIM generated by an international consortium provides a cohesive framework to ensure research focused on this topic extends across the criminal justice system. Preventing and improving interactions between autistic individuals and the criminal justice system is an urgent research, policy, and practice need

Fostering Data Literacy Teaching with Quantitative Data in the Social Sciences

Quantitative literacy is an essential twenty-first century skill that universities are heavily invested in teaching to students. The social sciences play an important role in these efforts because they attract students who might otherwise avoid data and mathematically oriented courses and because they ground quantitative reasoning in political and social contexts that resonate with undergraduates. However, pedagogical best practices for social science instructors have been slow to emerge and the support needs of instructors and students remain difficult to discern. Ithaka S+R’s Teaching Support Services program explores the teaching practices and support needs of collegiate instructors. Our most recent project in this program, “Teaching with Data in the Social Sciences,” focused on identifying the instructional goals and practices of instructors in introductory and advanced social science courses and exploring strengths and weaknesses of existing institutional support services. As part of this study, we partnered with librarians from 20 colleges and universities in the United States, who conducted 219 interviews with social science faculty. These interviews form the basis of this report. “Fostering Data Literacy: Teaching with Quantitative Data in the Social Sciences” explores why and how instructors teach with data, identifies the most important challenges they face, and describes how faculty and students utilize relevant campus and external resources. Full details and actionable recommendations for stakeholders are offered in the body of the report, which offers guidance to university libraries and other campus units, faculty, vendors, and others interested in improving institutional capacities to support data-intensive instruction in the social sciences

Does Colchicine Improve Pain in an Acute Gout Flare?

Low-quality evidence suggests that both high- and low-dose colchicine decreases pain in acute gout flares; however, high-dose regimens are associated with more frequent adverse effects

Privacy Considerations for Online Advertising: A Stakeholder’s Perspective to Programmatic Advertising

Purpose Privacy considerations have become a topic with increasing interest from academics, industry leaders and regulators. In response to consumers’ privacy concerns, Google announced in 2020 that Chrome would stop supporting third-party cookies in the near future. At the same time, advertising technology companies are developing alternative solutions for online targeting and consumer privacy controls. This paper aims to explore privacy considerations related to online tracking and targeting methods used for programmatic advertising (i.e. third-party cookies, Privacy Sandbox, Unified ID 2.0) for a variety of stakeholders: consumers, AdTech platforms, advertisers and publishers. Design/methodology/approach This study analyzes the topic of internet user privacy concerns, through a multi-pronged approach: industry conversations to collect information, a comprehensive review of trade publications and extensive empirical analysis. This study uses two methods to collect data on consumer preferences for privacy controls: a survey of a representative sample of US consumers and field data from conversations on web-forums created by tech professionals. Findings The results suggest that there are four main segments in the US internet user population. The first segment, consisting of 26% of internet users, is driven by a strong preference for relevant ads and includes consumers who accept the premises of both Privacy Sandbox and Unified ID (UID) 2.0. The second segment (26%) includes consumers who are ambivalent about both sets of premises. The third segment (34%) is driven by a need for relevant ads and a strong desire to prevent advertisers from aggressively collecting data, with consumers who accept the premises of Privacy Sandbox but reject the premises of UID 2.0. The fourth segment (15% of consumers) rejected both sets of premises about privacy control. Text analysis results suggest that the conversation around UID 2.0 is still nascent. Google Sandbox associations seem nominally positive, with sarcasm being an important factor in the sentiment analysis results. Originality/value The value of this paper lies in its multi-method examination of online privacy concerns in light of the recent regulatory legislation (i.e. General Data Protection Regulation and California Consumer Privacy Act) and changes for third-party cookies in browsers such as Firefox, Safari and Chrome. Two alternatives proposed to replace third-party cookies (Privacy Sandbox and Unified ID 2.0) are in the proposal and prototype stage. The elimination of third-party cookies will affect stakeholders, including different types of players in the AdTech industry and internet users. This paper analyzes how two alternative proposals for privacy control align with the interests of several stakeholders. Click here to watch a video abstract for this paper