Aspects of growth and production of Laminaria pallida (Grev.) J. Ag. off the Cape Peninsula

Bibliography: pages 91-98.Growth rates, chemical composition and annual production by sporophytes of Laminaria pallida at different localities and depths have been investigated. Growth of L. pallida fronds measured as rates of frond elongation was seasonal and showed similar trends at Robben Island and Oudekraal and at different depths. Frond elongation rates of up to 1,3 cm dayˉ¹ were recorded in spring and early summer, whilst slow rates of 0,2 cm dayˉ¹ were measured in late autumn and winter at all stations. The seasonal cycle of frond elongation rates appeared to be regulated by more than one abiotic factor, with light probably being the most important one. Differences in stipe elongation rates of sporophytes growing 50 m apart, but at different depths, confirmed that light was an important factor in determining growth rates; at 8 m depth stipes attained a length of approximately 240 cm within five years, whereas stipes growing at 14 m depth only grew to a length of approximately 200 cm in nine years

The development of a tool to assess medical students’ non-technical skills–The Norwegian medical students’ non-technical skills (NorMS-NTS)

Purpose - New physicians need to master non-technical skills (NTS), as high levels of NTS have been shown to increase patient safety. It has also been shown that NTS can be improved through training. This study aimed to establish the necessary NTS for Norwegian medical students to create a tool for formative and summative assessments. Methods - Focus group interviews were conducted with colleagues and patients of newly graduated physicians. Interviews were then analyzed using card sort methods, and the identified NTS were used to establish a framework. Focus groups commented on a prototype of an NTS assessment tool. Finally, we conducted a search of existing tools and literature. The final tool was developed based on the combined inputs. Results - We created Norwegian medical students’ non-technical skills (NorMS-NTS) assessment tool containing four main categories; together comprising 13 elements and a rating scale for the NTS of the person observed. Conclusions - The NorMS-NTS represents a purpose-made tool for assessing newly graduated physicians’ NTS. It is similar to existing assessment tools but based on domain-specific user perspectives obtained through focus group interviews and feedback, integrated with results from a literature search, and with consideration of existing NTS tools

Promoting medical student engagement through co-development and peer-assisted learning: a new patient safety course as a case study

Introduction Peer-assisted learning programs have been focused on providing students with competencies to deliver lectures and facilitate workshops, whereas involvement of students as co-developers of educational programmes has been relatively under-described in the literature. Likewise, the use of students as facilitators in simulation-based training and debriefing is also scarce. In this paper, we describe how medical students were co-developers of a novel course on patient safety and how they were trained as student facilitators to conduct simulation-based training and debriefing, as well as workshops. Methods Medical students co-developed a course in patient safety consisting of three simulation-based scenarios and three workshops. The students were educated in relevant patient safety topics. They were trained to become student facilitators to conduct workshops, simulations and debriefings at a patient safety course for medical students. A questionnaire was developed to evaluate the course participants´ perception of the learning objectives and the student facilitators following the latest course in 2020. In addition, semi-structured interviews with the student facilitators were conducted to explore their perceptions of being part of the course. Results A total of 92% of the course participants completed the evaluation of the course. The majority of the course participants found that the student facilitators created a safe learning environment and had the necessary skills to teach. The learning objectives for the course were found to be useful. A total of 10 interviews with the student facilitators were conducted. We found that the student facilitators were motivated to teach in the course, as a way of improving their teamwork, leadership qualities and communication skills, as well as their resume. Some of the student facilitators mentioned that they were able to create a safe learning environment, whereas others mentioned a feeling of inadequacy for their teacher role. In addition to developing their teaching skills, they mentioned that they developed their medical expertise, alongside their communication-, collaboration-, leadership- and professional skills. Conclusion This study illustrates how medical students were involved in the co-development, delivery and implementation of a course in patient safety. The evaluation of the course shows that student facilitators succeeded in creating a safe learning environment. The interviews of the student facilitators reveal their various motivations for teaching, in addition to different perceptions of their experience as a student facilitator. Some expressed a positive feeling of being able to establish a safe learning environment, whilst others expressed a feeling of inadequacy when facilitating peers. In addition, the student facilitators indicated that they developed themselves both professionally and personally.publishedVersio

Collecting evidence of validity for an assessment tool for Norwegian medical students' non-technical skills (NorMS-NTS): usability and reliability when used by novice raters

Background - The NorMS-NTS tool is an assessment tool for assessing Norwegian medical students’ non-technical skills (NTS). The NorMS-NTS was designed to provide student feedback, training evaluations, and skill-level comparisons among students at different study sites. Rather than requiring extensive rater training, the tool should capably suit the needs of busy doctors as near-peer educators. The aim of this study was to examine the usability and preliminary assess validity of the NorMS-NTS tool when used by novice raters. Methods - This study focused on the usability of the assessment tool and its internal structure. Three raters used the NorMS-NTS tool to individually rate the team leader, a medical student, in 20 video-recorded multi-professional simulation-based team trainings. Based on these ratings, we examined the tools’ internal structure by calculating the intraclass correlation coefficient (ICC) (version 3.1) interrater reliability, internal consistency, and observability. After the rating process was completed, the raters answered a questionnaire about the tool’s usability. Results - The ICC agreement and the sum of the overall global scores for all raters were fair: ICC (3,1) = 0.53. The correlation coefficients for the pooled raters were in the range of 0.77–0.91. Cronbach’s alpha for elements, categories and global score were mostly above 0.90. The observability was high (95%-100%). All the raters found the tool easy to use, none of the elements were redundant, and the written instructions were helpful. The raters also found the tool easier to use once they had acclimated to it. All the raters stated that they could use the tool for both training and teaching. Conclusions - The observed ICC agreement was 0.08 below the suggested ICC level for formative assessment (above 0.60). However, we know that the suggestion is based on the average ICC, which is always higher than a single-measure ICC. There are currently no suggested levels for single-measure ICC, but other validated NTS tools have single-measure ICC in the same range. We consider NorMS-NTS as a usable tool for formative assessment of Norwegian medical students’ non-technical skills during multi-professional team training by raters who are new to the tool. It is necessary to further examine validity and the consequences of the tool to fully validate it for formative assessments

Laboratory study on coprecipitation of phosphate with ikaite in sea ice

Ikaite (CaCO3�6H2O) has recently been discovered in sea ice, providing first direct evidence of CaCO3 precipitation in sea ice. However, the impact of ikaite precipitation on phosphate (PO4) concentration has not been considered so far. Experiments were set up at pH from 8.5 to 10.0, salinities from 0 to 105, temperatures from 24°C to 0°C, and PO4 concentrations from 5 to 50 mmol kg-1 in artificial sea ice brine so as to understand how ikaite precipitation affects the PO4 concentration in sea ice under different conditions. Our results show that PO4 is coprecipitated with ikaite under all experimental conditions. The amount of PO4 removed by ikaite precipitation increases with increasing pH. Changes in salinity (S >=35) as well as temperature have little impact on PO4 removal by ikaite precipitation. The initial PO4 concentration affects the PO4 coprecipitation. These findings may shed some light on the observed variability of PO4 concentration in sea ice

The impact of dissolved organic carbon and bacterial respiration on pCO2 in experimental sea ice

Previous observations have shown that the partial pressure of carbon dioxide (pCO2) in sea ice brines is generally higher in Arctic sea ice compared to those from the Antarctic sea ice, especially in winter and early spring. We hypothesized that these differences result from the higher dissolved organic carbon (DOC) content in Arctic seawater: Higher concentrations of DOC in seawater would be reflected in a greater DOC incorporation into sea ice, enhancing bacterial respiration, which in turn would increase the pCO2 in the ice. To verify this hypothesis, we performed an experiment using two series of mesocosms: one was filled with seawater (SW) and the other one with seawater with an addition of filtered humic-rich river water (SWR). The addition of river water increased the DOC concentration of the water from a median of 142 µmol Lwater-1 in SW to 249 µmol Lwater-1 in SWR. Sea ice was grown in these mesocosms under the same physical conditions over 19 days. Microalgae and protists were absent, and only bacterial activity has been detected. We measured the DOC concentration, bacterial respiration, total alkalinity and pCO2 in sea ice and the underlying seawater, and we calculated the changes in dissolved inorganic carbon (DIC) in both media. We found that bacterial respiration in ice was higher in SWR: median bacterial respiration was 25 nmol C Lice-1 h-1 compared to 10 nmol C Lice-1 h-1 in SW. pCO2 in ice was also higher in SWR with a median of 430 ppm compared to 356 ppm in SW. However, the differences in pCO2 were larger within the ice interiors than at the surfaces or the bottom layers of the ice, where exchanges at the air–ice and ice–water interfaces might have reduced the differences. In addition, we used a model to simulate the differences of pCO2 and DIC based on bacterial respiration. The model simulations support the experimental findings and further suggest that bacterial growth efficiency in the ice might approach 0.15 and 0.2. It is thus credible that the higher pCO2 in Arctic sea ice brines compared with those from the Antarctic sea ice were due to an elevated bacterial respiration, sustained by higher riverine DOC loads. These conclusions should hold for locations and time frames when bacterial activity is relatively dominant compared to algal activity, considering our experimental conditions

Okay, let's talk - short debriefings in the operating room

Introduction Debriefing is increasingly used to enhance learning and reflection in clinical practice. Nevertheless, barriers to implementing debriefings in the operating room (OR) include lack of time, the availability of trained facilitators, and difficulty gathering the full team after surgery. Spending five minutes on a debriefing during skin closure or between procedures may enhance learning and reflection on practice, generating to improve patient safety. The aim of this study was to explore characteristics, feasibility and content of short debriefings in the OR. Methods This was a mixed-method study of short debriefings, analyzing audio-recordings, field notes and relevance ratings from multi-professional teams, that conducted short debriefings in the OR at two University Hospitals in Denmark. Results A total of 135 debriefings were conducted, with a median duration of five minutes (range 1:19 min–12:05 min). A total of 477 team members participated in the debriefings. The teams’ median rating of relevance was 6 (range 1–10). The rating was higher following challenging events and in debriefings where the surgeon actively participated in the conversation. The teams discussed non-technical skills in all the debriefings and verbalized reflections on practice in 75 percent of the debriefings. Conclusion It was feasible to conduct short debriefings in a production-focused, complex work environment. In all the debriefings, the teams discussed various non-technical skills (NTS) and reflected on practice. The majority of team members rated the debriefings as relevant for their task management.publishedVersio

Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation

Abstract Background Simulation-based medical education (SBME) has traditionally been conducted as off-site simulation in simulation centres. Some hospital departments also provide off-site simulation using in-house training room(s) set up for simulation away from the clinical setting, and these activities are called in-house training. In-house training facilities can be part of hospital departments and resemble to some extent simulation centres but often have less technical equipment. In situ simulation, introduced over the past decade, mainly comprises of team-based activities and occurs in patient care units with healthcare professionals in their own working environment. Thus, this intentional blend of simulation and real working environments means that in situ simulation brings simulation to the real working environment and provides training where people work. In situ simulation can be either announced or unannounced, the latter also known as a drill. This article presents and discusses the design of SBME and the advantage and disadvantage of the different simulation settings, such as training in simulation-centres, in-house simulations in hospital departments, announced or unannounced in situ simulations. Discussion Non-randomised studies argue that in situ simulation is more effective for educational purposes than other types of simulation settings. Conversely, the few comparison studies that exist, either randomised or retrospective, show that choice of setting does not seem to influence individual or team learning. However, hospital department-based simulations, such as in-house simulation and in situ simulation, lead to a gain in organisational learning. To our knowledge no studies have compared announced and unannounced in situ simulation. The literature suggests some improved organisational learning from unannounced in situ simulation; however, unannounced in situ simulation was also found to be challenging to plan and conduct, and more stressful among participants. The importance of setting, context and fidelity are discussed. Summary Based on the current limited research we suggest that choice of setting for simulations does not seem to influence individual and team learning. Department-based local simulation, such as simulation in-house and especially in situ simulation, leads to gains in organisational learning. The overall objectives of simulation-based education and factors such as feasibility can help determine choice of simulation setting