Can enriching emotional intelligence improve medical students' proactivity and adaptability during OB/GYN clerkships?

Abstract Objective: The purpose of this pilot study was to examine our hypothesis that enriching workplace emotional intelligence through resident coaches could improve third-year medical students' adaptability and proactivity on the Obstetrics and Gynecology clerkship. Methods: An observational pilot study was conducted in a teaching hospital. Fourteen 3rd year medical students from two cohorts of clerkships were randomly divided into two groups, and equally assigned to trained resident coaches and untrained resident coaches. Data was collected through onsite naturalistic observation of students' adaptability and proactivity in clinical settings using a checklist with a 4-point Likert scale (1=poor to 4=excellent). Wilcoxon ranksum test was used to compare the differences between these two groups. Results: A total of 280 data points were collected through onsite observations conducted by investigators. All (n=14) students' adaptability and proactivity performance significantly improved from an average of 3.04 to 3.45 (p=0.014) over 6-week clerkship. Overall, students with trained resident coaches adapted significantly faster and were more proactive in the obstetrics and gynecology clinical setting than the students with untrained coaches (3.31 vs. 3.24, p=0.019). Conclusions: Findings from our pilot study supported our hypothesis that enriching workplace emotional intelligence knowledge through resident coaches was able to help medical students adapt into obstetrics and gynecology clinical settings faster and become more proactive in learning. Clerkship programs can incorporate the concept of a resident coach in their curriculum to help bridge medical students into clinical settings and to help them engage in self-directed learning throughout the rotation

The Role of Prior Knowledge in the Development of Strategy Flexibility: The Case of Computational Estimation

The ability to estimate is a fundamental real-world skill; it allows students to check the reasonableness of answers found through other means, and it can help students develop a better understanding of place value, mathematical operations, and general number sense. Flexibility in the use of strategies is particularly critical in computational estimation. The ability to perform complex calculations mentally is cognitively challenging for many students; thus it is important to have a broad repertoire of estimation strategies and to select the most appropriate strategy for a given problem. In this paper, we consider the role of students' prior knowledge of estimation strategies in the effectiveness of interventions designed to promote strategy flexibility across two recent studies. In the first, 65 fifth graders began the study as fluent users of one strategy for computing mental estimates to multi-digit multiplication problems such as 17 x 41. In the second, 157 fifth and sixth graders began the study with moderate to low prior knowledge of strategies for computing mental estimates. Results indicated that students' fluency with estimation strategies had an impact on which strategies they adopted. Students who exhibited high fluency at pretest were more likely to increase use of estimation strategies that led to more accurate estimates, while students with less fluency adopted strategies that were easiest to implement. Our results suggest that both the ease and accuracy of strategies as well as students’ fluency with strategies are all important factors in the development of strategy flexibility

Does implementation matter if comprehension is lacking? A qualitative investigation into perceptions of advance care planning in people with cancer

Purpose: While advance care planning holds promise, uptake is variable and it is unclear how well people engage with or comprehend advance care planning. The objective of this study was to explore how people with cancer comprehended Advance Care Plans and examine how accurately advance care planning documentation represented patient wishes. Methods: This study used a qualitative descriptive design. Data collection comprised interviews and an examination of participants’ existing advance care planning documentation. Participants included those who had any diagnosis of cancer with an advance care plan recorded: Refusal of Treatment Certificate; Statement of Choices; and/or Enduring Power of Attorney (Medical Treatment) at one cancer treatment centre. Results: Fourteen participants were involved in the study. Twelve participants were female (86%). The mean age was 77 (range: 61-91) and participants had completed their advance care planning documentation between 8 and 72 weeks prior to the interview (mean 33 weeks). Three themes were evident from the data: Incomplete advance care planning understanding and confidence; Limited congruence for attitude and documentation; Advance care planning can enable peace of mind. Complete advance care planning understanding was unusual; most participants demonstrated partial comprehension of their own advance care plan, and some indicated very limited understanding. Participants’ attitudes and their written document congruence was limited, but advance care planning was seen as helpful. Conclusions: This study highlighted advance care planning was not a completely accurate representation of patient wishes. There is opportunity to improve how patients comprehend their own advance care planning documentation

Haptic-enabled collaborative learning in virtual reality for schools

This paper reports on a study which designed and developed a multi-fingered haptic interface in conjunction with a three-dimensional (3D) virtual model of a section of the cell membrane in order to enable students to work collaboratively to learn cell biology. Furthermore, the study investigated whether the addition of haptic feedback to the 3D virtual reality (VR) simulation affected learning of key concepts in nanoscale cell biology for students aged 12 to 13. The haptic interface was designed so that the haptic feedback could be turned on or switched off. Students (N = 64), in two secondary schools, worked in pairs, on activities designed to support learning of specific difficult concepts. Findings from observation of the activities and interviews revealed that students believed that being immersed in the 3D VR environment and being able to feel structures and movements within the model and work collaboratively assisted their learning. More specifically, the pilot/co-pilot model that we developed was successful for enabling collaborative learning and reducing the isolating effects of immersion with a 3D headset. Results of pre and post-tests of conceptual knowledge showed significant knowledge gains but addition of haptic feedback did not affect the knowledge gains significantly. The study enabled identification of important issues to consider when designing and using haptic-enabled 3D VR environments for collaborative learning

Endometrial Intraepithelial Neoplasia Clinical Correlates and Outcomes

Objective To estimate cancer outcome and outcome predictors of women with endometrial intraepithelial neoplasia (EIN). Methods Outcomes of women with first diagnosis of EIN (“index biopsy”) was determined by follow-up pathology. Patient characteristics were correlated with EIN regression, EIN persistence, and progression to cancer. Results Fifteen percent (9.8-20.8%, 26/177) of index EIN biopsies had concurrent cancer. Of the women with cancer-free index EIN biopsies, and follow-up by hysterectomy or more than 18 months surveillance, 25% (18.4-33.3%, 36/142) showed regression, 35% (27.4-43.7%, 50/142) persistence, and 39% (31.3-48.0%, 56/142) progression. Non-white ethnicity and progestin treatment reduced cancer outcomes (OR 0.16 (0.03,0.84) and 0.24 (0.08, 0.70) respectively), while body mass index (BMI) greater than 25 increased malignant outcomes (BMI 25 or higher, OR 3.05 (1.10,8.45)). Conclusion EIN confers a high risk of cancer, but individual patient outcomes cannot be predicted. Management should include exclusion of concurrent carcinoma and consideration of hysterectomy

Clinical Manifestations and Case Management of Ebola Haemorrhagic Fever caused by a newly identified virus strain, Bundibugyo, Uganda, 2007-2008

A confirmed Ebola haemorrhagic fever (EHF) outbreak in Bundibugyo, Uganda, November 2007-February 2008, was caused by a putative new species (Bundibugyo ebolavirus). It included 93 putative cases, 56 laboratory-confirmed cases, and 37 deaths (CFR = 25%). Study objectives are to describe clinical manifestations and case management for 26 hospitalised laboratory-confirmed EHF patients. Clinical findings are congruous with previously reported EHF infections. The most frequently experienced symptoms were non-bloody diarrhoea (81%), severe headache (81%), and asthenia (77%). Seven patients reported or were observed with haemorrhagic symptoms, six of whom died. Ebola care remains difficult due to the resource-poor setting of outbreaks and the infection-control procedures required. However, quality data collection is essential to evaluate case definitions and therapeutic interventions, and needs improvement in future epidemics. Organizations usually involved in EHF case management have a particular responsibility in this respect

Seed Transmission of Epichloë Endophytes in Lolium perenne Is Heavily Influenced by Host Genetics

Vertical transmission of symbiotic Epichloë endophytes from host grasses into progeny seed is the primary mechanism by which the next generation of plants is colonized. This process is often imperfect, resulting in endophyte-free seedlings which may have poor ecological fitness if the endophyte confers protective benefits to its host. In this study, we investigated the influence of host genetics and environment on the vertical transmission of Epichloë festucae var. lolii strain AR37 in the temperate forage grass Lolium perenne. The efficiency of AR37 transmission into the seed of over 500 plant genotypes from five genetically diverse breeding populations was determined. In Populations I–III, which had undergone previous selection for high seed infection by AR37, mean transmission was 88, 93, and 92%, respectively. However, in Populations IV and V, which had not undergone previous selection, mean transmission was 69 and 70%, respectively. The transmission values, together with single-nucleotide polymorphism data obtained using genotyping-by-sequencing for each host, was used to develop a genomic prediction model for AR37 seed transmission. The predictive ability of the model was estimated at r = 0.54. While host genotype contributed greatly to differences in AR37 seed transmission, undefined environmental variables also contributed significantly to seed transmission across different years and geographic locations. There was evidence for a small host genotype-by-environment effect; however this was less pronounced than genotype or environment alone. Analysis of endophyte infection levels in parent plants within Populations I and IV revealed a loss of endophyte infection over time in Population IV only. This population also had lower average tiller infection frequencies than Population I, suggesting that AR37 failed to colonize all the daughter tillers and therefore seeds. However, we also observed that infection of seed by AR37 may fail during or after initiation of floral development from plants where all tillers remained endophyte-infected over time. While the effects of environment and host genotype on fungal endophyte transmission have been evaluated previously, this is the first study that quantifies the relative impacts of host genetics and environment on endophyte vertical transmission

3B11-N, a monoclonal antibody against MERS-CoV, reduces lung pathology in rhesus monkeys following intratracheal inoculation of MERS-CoV Jordan-n3/2012

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was identified in 2012 as the causative agent of a severe, lethal respiratory disease occurring across several countries in the Middle East. To date there have been over 1,600 laboratory confirmed cases of MERS-CoV in 26 countries with a case fatality rate of 36%. Given the endemic region, it is possible that MERS-CoV could spread during the annual Hajj pilgrimage, necessitating countermeasure development. In this report, we describe the clinical and radiographic changes of rhesus monkeys following infection with 5×106 PFU MERS-CoV Jordan-n3/2012. Two groups of NHPs were treated with either a human anti-MERS monoclonal antibody 3B11-N or E410-N, an anti-HIV antibody. MERS-CoV Jordan-n3/2012 infection resulted in quantifiable changes by computed tomography, but limited other clinical signs of disease. 3B11-N treated subjects developed significantly reduced lung pathology when compared to infected, untreated subjects, indicating that this antibody may be a suitable MERS-CoV treatment

An RCT of dating matters:Effects on teen dating violence and relationship behaviors

Introduction Teen dating violence is a serious public health problem with few effective prevention strategies. This study examines whether the Dating Matters comprehensive prevention model, compared with a standard of care intervention, prevented negative relationship behaviors and promoted positive relationship behaviors. Study design This longitudinal, cluster-RCT compared the effectiveness of Dating Matters with standard of care across middle school. Standard of care was an evidence-based teen dating violence prevention curriculum (Safe Dates) implemented in eighth grade. Setting/participants Forty-six middle schools in high-risk urban neighborhoods in four U.S. cities were randomized. Schools lost to follow-up were replaced with new schools, which were independently randomized (71% school retention). Students were surveyed in fall and spring of sixth, seventh, and eighth grades (2012–2016). The analysis sample includes students from schools implementing Dating Matters or standard of care for >2 years who started sixth grade in the fall of 2012 or 2013 and had dated (N=2,349 students, mean age 12 years, 49% female, and 55% black, non-Hispanic, 28% Hispanic, 17% other). Intervention Dating Matters is a comprehensive, multicomponent prevention model including classroom-delivered programs for sixth to eighth graders, training for parents of sixth to eighth graders, educator training, a youth communications program, and local health department activities to assess capacity and track teen dating violence–related policy and data. Main outcome measures Self-reported teen dating violence perpetration and victimization, use of negative conflict resolution strategies, and positive relationship skills were examined as outcomes. Imputation and analyses were conducted in 2017. Results Latent panel models demonstrated significant program effects for three of four outcomes; Dating Matters students reported 8.43% lower teen dating violence perpetration, 9.78% lower teen dating violence victimization, and 5.52% lower use of negative conflict resolution strategies, on average across time points and cohorts, than standard of care students. There were no significant effects on positive relationship behaviors. Conclusions Dating Matters demonstrates comparative effectiveness, through middle school, for reducing unhealthy relationship behaviors, such as teen dating violence and use of negative conflict resolution strategies, relative to the standard of care intervention