Simulation and Quality in Clinical Education

Abstract Background Simulation-based education (SBE) has become commonplace in healthcare education within hospitals, higher education institutions, the private healthcare sector, and private education providers. The standards and quality of delivery vary across the UK (1), leading to differing degrees of learning for healthcare professionals. This variance in standards makes research into the impact of SBE on the end user (the patient) difficult to measure. Review The delivery of SBE needs to be of a high standard if learning via this pedagogy is to be maximised and benefits to patients accurately assessed. This article aims to summarise the importance of quality within clinical SBE and how it can be achieved and maintained to produce a measurable impact on patient care. The current progress of the implementation of UK national standards for SBE is included to highlight the need for standardisation and guidance to support simulation centres and individuals to benchmark practice and work towards accreditation through quality measurement and monitoring processes. Suggestions are made on how such standards will affect the future of SBE and all those involved. Conclusion There is a clear need for the development of national standards for SBE delivery and for a stepped approach [i.e. minimum, intermediate, and advanced standards] depending on the size, capacity, and frequency of SBE education delivery. Considerable financial outlay will be required to monitor standards effectively. The enhanced use of current and future technologies should be considered with regards to monitoring standards as well as data collection for future research opportunities. Keywords Simulation, quality improvement, educational standard

Effect of ambient temperature during acute aerobic exercise on short-term appetite, energy intake, and plasma acylated ghrelin in recreationally active males

Ambient temperature during exercise may affect energy intake regulation. Compared with a temperate (20 °C) environment, 1 h of running followed by 6 h of rest tended to decrease energy intake from 2 ad libitum meals in a hot (30 °C) environment but increase energy intake in a cool (10 °C) environment (p = 0.08). Core temperature changes did not appear to mediate this trend; whether acylated ghrelin is involved is unclear. Further research is warranted to clarify these findings

Surgical management of posterior fossa metastases

The diagnosis of brain metastases is associated with a poor prognosis reflecting uncontrolled primary disease that has spread to the relative sanctuary of the central nervous system. 20 % of brain metastases occur in the posterior fossa and are associated with significant morbidity. The risk of acute hydrocephalus and potential for sudden death means these metastases are often dealt with as emergency cases. This approach means a full pre-operative assessment and staging of underlying disease may be neglected and a proportion of patients undergo comparatively high risk surgery with little or no survival benefit. This study aimed to assess outcomes in patients to identify factors that may assist in case selection. We report a retrospective case series of 92 consecutive patients operated for posterior fossa metastases between 2007 and 2012. Routine demographic data was collected plus data on performance status, primary cancer site, details of surgery, adjuvant treatment and survival. The only independent positive prognostic factors identified on multivariate analysis were good performance status (if Karnofsky performance score >70, hazard ratio (HR) for death 0.36, 95 % confidence interval (CI) 0.18–0.69), adjuvant whole brain radiotherapy (HR 0.37, 95 % CI 0.21–0.65) and adjuvant chemotherapy where there was extracranial disease and non-synchronous presentation (HR 0.51, 95 % CI 0.31–0.82). Patients presenting with posterior fossa metastases may not be investigated as thoroughly as those with supratentorial tumours. Staging and assessment is essential however, and in the meantime emergencies related to tumour mass effect should be managed with steroids and cerebrospinal fluid diversion as required

The quantification of wind turbulence by means of the fourier dimension

Signal Processing within the frequency domain has long been associated with electrical engineering as a means to quantify the characteristics of voltage/current waveforms. Historically, wind speed data (speed/direction) have been captured and stored as statistical markers within a time series description. This form of storage, while cumbersome, is applicable in wind regimes that are relatively laminar. In urban environments, where the associated topographies and building morphologies are heterogeneous, wind speeds are highly turbulent and chaotic. In such environments and with particular reference to wind energy, time series statistics are of limited use, unless the generic probability distribution function (PDF) is also considered. Furthermore, the industry standard metric that quantifies the turbulent component of wind speed, Turbulence Intensity (TI), is computationally cumbersome and resource intensive. An alternative model to quantify turbulence is proposed here. This paper will describe how Fourier dimension modelling (Df), through linkage with the Weibull probability density function, can quantify turbulence in a more efficient manner. This model could potentially be developed to facilitate urban wind power prediction and is relevant to the planning and development considerations within the built environment

Teacher Turnover: Examining Exit Attrition, Teaching Area Transfer, and School Migration

The purposes of this research were to quantify trends in three components of teacher turnover and to investigate claims of excessive teacher turnover as the predominant source of teacher shortages. Attrition and teaching area transfer rates were comparable in special and general education and increased substantially from 1991-1992 to 2000-2001. School migration was stable over years, but higher in special than general education. Although annual turnover was high and increased to 1 in 4 teachers (25.6%) by 2000-2001, teacher attrition was lower than in other occupations. Evidence suggests that retention is unlikely to increase without dramatic improvements in the organization, management, and funding of public schools. Until then, an increased supply of qualified teachers is needed to reduce teacher shortages

Gender and language in sub-Saharan African contexts: Issues and challenges

In this paper, we examine a range of issues associated with the study of gender and language in sub-Saharan African contexts. These include whether (and in what sense) such contexts may constitute a ‘special case’, the relevance of feminism, and what might be encompassed by ‘context’, ‘African contexts’ and ‘African topics’ – and a substantial amount of what we write is relevant to Applied Linguistics in Africa more broadly (see Makoni and Meinhof 2004 for a discussion). We argue that while all the gender issues are of interest and importance to language and gender study in general, it is possible to see some of these issues as ‘characteristic’ of African contexts (albeit with ‘echoes’ elsewhere). It will be evident from this first paper (and those which follow) that along with taking on board commonalities in terms of the theoretical notions used in our field in African and non-African contexts, there is also a need to recognise a range of situated understandings of gender identities, gender relations, understandings of gender more broadly, and feminism

Mercury Exposure from Domestic and Imported Estuarine and Marine Fish in the U.S. Seafood Market

BACKGROUND: Methylmercury exposure causes a variety of adverse effects on human health. Per capita estimates of mercury exposure are critical for risk assessments and for developing effective risk management strategies. OBJECTIVE: This study investigated the impact of natural stochasticity in mercury concentrations among fish and shellfish harvested from the Atlantic Ocean, Pacific Ocean, and foreign shores on estimated mercury exposures. METHODS: Mercury concentrations and seafood consumption are grouped by supply region (Atlantic Ocean, Pacific Ocean, and foreign shores). Distributions of intakes from this study are compared with values obtained using national FDA (Food and Drug Administration) mercury survey data to assess the significance of geographic variability in mercury concentrations on exposure estimates. RESULTS: Per capita mercury intake rates calculated using FDA mercury data differ significantly from those based on mercury concentration data for each supply area and intakes calculated for the 90th percentile of mercury concentrations. CONCLUSIONS: Differences in reported mercury concentrations can significantly affect per capita mercury intake estimates, pointing to the importance of spatially refined mercury concentration data. This analysis shows that national exposure estimates are most influenced by reported concentrations in imported tuna, swordfish, and shrimp; Pacific pollock; and Atlantic crabs. Collecting additional mercury concentration data for these seafood categories would improve the accuracy of national exposure estimates

Comparison of bioactivities, binding properties and intra-follicular levels of bovine follistatins

Five isoforms of follistatin (FST) (Mr 31, 33, 35, 37, 41kDa) were purified from bovine follicular fluid (bFF). Comparison of their activin- and heparan sulphate proteoglycan (HSP)-binding properties and bio-potencies in neutralization of activin-A action in vitro revealed that all five isoforms bound activin-A, but with different affinities. Only the 31kDa isoform (FST-288) bound to HSP. FST-288 also showed the greatest biopotency with 35 and 41kDa isoforms being least potent. To determine whether bovine follicle development is associated with changing intrafollicular FST and activin profiles, we analyzed bFF from dominant (DF) and subordinate (SF) follicles collected at strategic times during a synchronized estrous cycle. Total FST, activin-A and activin-AB were measured by immunoassay while individual FST isoforms were quantified by immunoblotting. Follicle diameter was positively correlated with estrogen:progesterone ratio (r=0.56) in bFF but negatively correlated with activin-A (r=-0.34), activin-AB (r=-0.80) and ‘total’ FST (r=-0.70) levels. Follicle diameter was positively correlated with abundance of the 41 kDa isoform (r=0.59) but negatively correlated with abundance of 33 and 31 kDa isoforms (r=-0.56, -0.41). Both follicle status (DF vs SF) and cycle stage affected total FST, activin-A, activin-B levels while follicle status, but not cycle stage, affected abundance of 41, 37, 33 and 31kDa FST isoforms. Collectively, these findings indicate that intrafollicular FST isoforms that differ in their ability to bind and neutralise activins and associate with cell-surface proteoglycans, show divergent changes during follicle development. Enhanced FST production may have an important negative role, either directly or via inhibition of the positive effects of activins, on follicle growth and function during follicular waves