Developing a Rapid Assessment Program for Student Success in Clinical Education

Successful management of the struggling student in the clinic relies heavily on the early identification of clinical performance deficits. CIs who directly observe student performance, actions and behaviors should aim for early and precise identification of difficulties, which should lead to initial discussions with the student. If the student\u27s struggles require involvement from the educational institution, the CI should promptly contact and collaborate with the DCE. Early communication with the DCE is beneficial, as they can provide support for CIs overwhelmed by the difficulties that accompany working with a challenging student. The DCE provides guidance on determining the depth of deficiencies, the student’s needs, and options for remediation. The Rapid Student Assessment and Review (R-STAR) Program was designed to facilitate a thorough and timely review of students’ Clinical Performance Instruments (CPIs)through partnership with expert clinical education faculty. With the increasing number of students in programs and the competing demands on Clinical Instructors (CIs), the successful management of the struggling student in the clinic relies heavily on the early identification of clinical performance deficits. Judicious review of CPI ratings and narratives is essential to identify discrepancies between the scores given and narrative comments. The R-STAR Program utilizes clinical partners who were carefully selected and specifically trained to review and provide feedback to students and CIs, while identifying those individuals with issues requiring the DCE to prioritize and address. This session describes how to develop an efficient and effective program that may be implemented to help facilitate the timely management of student assessments in clinical education to enhance success

Importance and Detection of Epithelial-to-Mesenchymal Transition (EMT) Phenotype in CTCs

The current dogma is that epithelial-to-mesenchymal transition (EMT) promotes circulating tumour cell (CTC) formation and is ultimately a driver of metastasis. There is also accumulating evidence that EMT-phenotype changes are commonly associated with therapy resistance. Thus, capturing EMT-phenotype CTCs is expected to yield important clinical information in regard to prognosis and response to therapy as well as allowing the study of metastatic processes. However, the isolation and identification of EMT-phenotype CTCs with commonly used isolation/detection methods are suboptimal, and current efforts on improving the isolation of EMT-phenotype CTCs are associated with pitfalls that need to be overcome. This chapter explores the significance of EMT in CTC formation and the role of EMT in cancer metastasis and resistance to therapy. We also comprehensively review the past and current limitations of evaluating EMT phenotypes in CTC isolation and analysis and discuss how CTCs can be seen in a more holistic fashion as important biomarkers for clinical management

Young carers in England: findings from the 2018 BBC survey on the prevalence and nature of caring among young people

Background Many young people are involved in caring for parents, siblings, or other relatives who have an illness or disability. The aim of this study was to estimate the prevalence of caring by young people in England. Method A national survey of 925 English young people was conducted using the 18‐item survey version of the Multidimensional Assessment of Caring Activities Checklist for Young Carers. Results Around 7% of young people were identified as doing at least a high amount of caring activity and 3% a very high amount. Most frequently, caring by a young person is for a mother or a sibling, with a physical disability. Caring activity consisted mostly of domestic activities, household management, and emotional care. Conclusion This study provides the most up to date and methodologically sophisticated survey data on the prevalence of young caring in England, with implications for policy and practice

Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO).

PURPOSE: To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department. METHODS: We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel. RESULTS: Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. Nearly 93% of programs are based at academic/teaching hospitals. 65% of programs are less than 5 years old, and 60% of programs perform ≤3 cases per year. Most programs (90%) had inpatient eCPR or salvage ECMO programs prior to starting ED ECMO programs. The majority of programs do not have formal inclusion and exclusion criteria. Most programs preferentially obtain vascular access via the percutaneous route (70%) and many (40%) use mechanical CPR during cannulation. The most commonly used console is the Maquet Rotaflow(®). Cannulation is most often performed by cardiothoracic (CT) surgery, and nearly all programs (\u3e85%) involve CT surgeons, perfusionists, and pharmacists. CONCLUSIONS: Over a third of centers that submitted adult eCPR cases to ELSO have performed ED ECMO. These programs are largely based at academic hospitals, new, and have low volumes. They do not have many formal inclusion or exclusion criteria, and devices and techniques are variable

How to specify, estimate, and validate higher-order constructs in PLS-SEM

Higher-order constructs, which facilitate modeling a construct on a more abstract higher-level dimension and its more concrete lower-order subdimensions, have become an increasingly visible trend in applications of partial least squares structural equation modeling (PLS-SEM). Unfortunately, researchers frequently confuse the specification, estimation, and validation of higher-order constructs, for example, when it comes to assessing their reliability and validity. Addressing this concern, this paper explains how to evaluate the results of higher-order constructs in PLS-SEM using the repeated indicators and the two-stage approaches, which feature prominently in applied social sciences research. Focusing on the reflective-reflective and reflective-formative types of higher-order constructs, we use the well-known corporate reputation model example to illustrate their specification, estimation, and validation. Thereby, we provide the guidance that scholars, marketing researchers, and practitioners need when using higher-order constructs in their studies

Three-Dimensional Model for the Human Cl−/HCO3− Exchanger, AE1, by Homology to the E. coli ClC Protein

AbstractAE1 mediates electroneutral 1:1 exchange of bicarbonate for chloride across the plasma membrane of erythrocytes and type A cells of the renal collecting duct. No high-resolution structure is available for the AE1 membrane domain, which alone is required for its transport activity. A recent electron microscopy structure of the AE1 membrane domain was proposed to have a similar protein fold to ClC chloride channels. We developed a three-dimensional homology model of the AE1 membrane domain, using the Escherichia coli ClC channel structure as a template. This model agrees well with a long list of biochemically established spatial constraints for AE1. To investigate the AE1 transport mechanism, we created point mutations in regions corresponding to E. coli ClC transport mechanism residues. When expressed in HEK293 cells, several mutants had Cl−/HCO3− exchange rates significantly different from that of wild-type AE1. When further assessed in Xenopus laevis oocytes, there were significant changes in the transport activity of several AE1 point mutants as assessed by changes in pH. None of the mutants, however, added an electrogenic component to AE1 transport activity. This indicates that the AE1 point mutants altered the transport activity of AE1, without changing its electrogenicity and stoichiometry. The homology model successfully identified residues in AE1 that are critical to AE1 transport activity. Thus, we conclude that AE1 has a similar protein fold to ClC chloride channels

Compactification in the Lightlike Limit

We study field theories in the limit that a compactified dimension becomes lightlike. In almost all cases the amplitudes at each order of perturbation theory diverge in the limit, due to strong interactions among the longitudinal zero modes. The lightlike limit generally exists nonperturbatively, but is more complicated than might have been assumed. Some implications for the matrix theory conjecture are discussed.Comment: 13 pages, 3 epsf figures. References and brief comments added. Nonexistent divergent graph in 0+- model delete

Moduli-Induced Vacuum Destabilisation

We look for ways to destabilise the vacuum. We describe how dense matter environments source a contribution to moduli potentials and analyse the conditions required to initiate either decompactification or a local shift in moduli vevs. We consider astrophysical objects such as neutron stars as well as cosmological and black hole singularities. Regrettably neutron stars cannot destabilise realistic Planck coupled moduli, which would require objects many orders of magnitude denser. However gravitational collapse, either in matter-dominated universes or in black hole formation, inevitably leads to a destabilisation of the compact volume causing a super-inflationary expansion of the extra dimensions.Comment: 21 pages, 12 figure

Designing a course to acculturate professional behaviors of international students in physical therapy education

The University of Nebraska Medical Center DPT program has a Global Health Opportunity track in which international students work on a master’s degree and complete a DPT. The current students are from China and meet all requirements of the DPT and graduate admissions, including a high proficiency in English (e.g. TOEFL ³ 90). All students have undergraduate degrees in medicine, rehabilitation therapy or medical sciences from universities in China. While these students have performed well in the didactic DPT curriculum, we noted a trend in professional interactions and communication which interfered with clinical performance and required remediation. To proactively circumvent these issues, we designed a course to develop an understanding of American culture, the US healthcare system, and professional behaviors required of physical therapists. Topics focused on themes of personal development, professionalism, interprofessional relationships, and communication. The course used self-reflection learning methods including mind maps, personal learning plans, and reflection papers to facilitate self-awareness and develop capacity for self-directed learning. Innovative Improv techniques and exercises taught communication skills related to body language and listening. Several experiences occurred in the community and the university setting to encourage practice of learned skills. This included interacting with an older adult fitness client and receiving feedback on this interaction from a DPT-2 student and engaging with stroke support group participants. The final project was an oral presentation with an impromptu question and answer session