Longitudinal evaluation, acceptability and long-term retention of knowledge on a horizontally integrated organic and functional systems course

Undergraduate medical education is moving from traditional disciplinary basic science courses into more integrated curricula. Integration models based on organ systems originated in the 1950s, but few longitudinal studies have evaluated their effectiveness. This article outlines the development and implementation of the Organic and Functional Systems (OFS) courses at the University of Minho in Portugal, using evidence collected over 10 years. It describes the organization of content, student academic performance and acceptability of the courses, the evaluation of preparedness for future courses and the retention of knowledge on basic sciences. Students consistently rated the OFS courses highly. Physician tutors in subsequent clinical attachments considered that students were appropriately prepared. Performance in the International Foundations of Medicine examination of a self-selected sample of students revealed similar performances in basic science items after the last OFS course and 4 years later, at the moment of graduation. In conclusion, the organizational and pedagogical approaches of the OFS courses achieve high acceptability by students and result in positive outcomes in terms of preparedness for subsequent training and long-term retention of basic science knowledge

Teaching About Health Care Disparities in the Clinical Setting

Clinical teachers often observe interactions that may contribute to health care disparities, yet may hesitate to teach about them. A pedagogical model could help faculty structure teaching about health care disparities in the clinical setting, but to our knowledge, none have been adapted for this purpose. In this paper, we adapt an established model, Time-Effective Strategies for Teaching (TEST), to the teaching of health care disparities. We use several case scenarios to illustrate the core components of the model: diagnose the learner, teach rapidly to the learner’s need, and provide feedback. The TEST model is straightforward, easy to use, and enables the incorporation of teaching about health care disparities into routine clinical teaching

Longitudinal, population-based study of racial/ethnic differences in colorectal cancer survival: impact of neighborhood socioeconomic status, treatment and comorbidity

<p>Abstract</p> <p>Background</p> <p>Colorectal cancer, if detected early, has greater than 90% 5-year survival. However, survival has been shown to vary across racial/ethnic groups in the United States, despite the availability of early detection methods.</p> <p>Methods</p> <p>This study evaluated the joint effects of sociodemographic factors, tumor characteristics, census-based socioeconomic status (SES), treatment, and comorbidities on survival after colorectal cancer among and within racial/ethnic groups, using the SEER-Medicare database for patients diagnosed in 1992–1996, and followed through 1999.</p> <p>Results</p> <p>Unadjusted colorectal cancer-specific mortality rates were higher among Blacks and Hispanic males than whites (relative rates (95% confidence intervals) = 1.34 (1.26–1.42) and 1.16 (1.04–1.29), respectively), and lower among Japanese (0.78 (0.70–0.88)). These patterns were evident for all-cause mortality, although the magnitude of the disparity was larger for colorectal cancer mortality. Adjustment for stage accounted for the higher rate among Hispanic males and most of the lower rate among Japanese. Among Blacks, stage and SES accounted for about half of the higher rate relative to Whites, and within stage III colon and stages II/III rectal cancer, SES completely accounted for the small differentials in survival between Blacks and Whites. Comorbidity did not appear to explain the Black-White differentials in colorectal-specific nor all-cause mortality, beyond stage, and treatment (surgery, radiation, chemotherapy) explained a very small proportion of the Black-White difference. The fully-adjusted relative mortality rates comparing Blacks to Whites was 1.14 (1.09–1.20) for all-cause mortality and 1.21 (1.14–1.29) for colorectal cancer specific mortality. The sociodemographic, tumor, and treatment characteristics also had different impacts on mortality within racial/ethnic groups.</p> <p>Conclusion</p> <p>In this comprehensive analysis, race/ethnic-specific models revealed differential effects of covariates on survival after colorectal cancer within each group, suggesting that different strategies may be necessary to improve survival in each group. Among Blacks, half of the differential in survival after colorectal cancer was primarily attributable to stage and SES, but differences in survival between Blacks and Whites remain unexplained with the data available in this comprehensive, population-based, analysis.</p

Up/down impurity density asymmetries in C-Mod plasmas

Brightness profiles of x-ray emission from H-like Ar17+ exhibit a distinct up/down asymmetry under certain operating conditions in C-Mod plasmas, indicating that impurity densities are not constant on flux surfaces with r/a between  ~0.8 and  ~0.95. In L- and I-mode plasmas, there is an x-ray brightness excess, up to a factor of 8, on the side opposite to the ion B  ×   B drift direction. This effect is not observed in H-mode plasmas, presumably due to edge impurity transport being dominated by a strong inward pinch, which is absent in L- and I-mode. The magnitude of the asymmetry in L- and I-mode decreases with increasing plasma current, similar to the observed decrease in radial impurity diffusivity. In I-mode, where the codependence between electron density and temperature can be broken with ICRF heating power, the asymmetry magnitude is found to decrease with increasing density and with increasing edge temperature at fixed density. These measurements exhibit some qualitative features of neo-classical expectations but the observed asymmetry magnitude is much larger than predicted and some scalings with plasma parameters are not seen. The up/down asymmetry appears to be largest when the cross field impurity diffusivity is the highest

Local variables affecting H-mode threshold on alcator C-mod

An edge temperature threshold for the LH transition is found on the Alcator C-Mod tokamak. The critical temperature depends weakly on density and increases with B-T and with unfavourable drift direction. T-e at the H-L transition can be greater than or equal to the L-H threshold. Magnetic fluctuations are observed at some H-L transitions. Measured parameters are compared with H-mode theories, including nonlinear drift-ballooning code simulations

Up/down impurity density asymmetries in C-Mod plasmas

Brightness profiles of x-ray emission from H-like Ar17+ exhibit a distinct up/down asymmetry under certain operating conditions in C-Mod plasmas, indicating that impurity densities are not constant on flux surfaces with r/a between  ~0.8 and  ~0.95. In L- and I-mode plasmas, there is an x-ray brightness excess, up to a factor of 8, on the side opposite to the ion B  ×   B drift direction. This effect is not observed in H-mode plasmas, presumably due to edge impurity transport being dominated by a strong inward pinch, which is absent in L- and I-mode. The magnitude of the asymmetry in L- and I-mode decreases with increasing plasma current, similar to the observed decrease in radial impurity diffusivity. In I-mode, where the codependence between electron density and temperature can be broken with ICRF heating power, the asymmetry magnitude is found to decrease with increasing density and with increasing edge temperature at fixed density. These measurements exhibit some qualitative features of neo-classical expectations but the observed asymmetry magnitude is much larger than predicted and some scalings with plasma parameters are not seen. The up/down asymmetry appears to be largest when the cross field impurity diffusivity is the highest