Incorporating Literature Circles into a Fifth Grade Classroom

The focus of this project was to review available literature on literature circles within the framework of a balanced literacy program, and create materials to be used by fifth grade teachers as they work toward improving their language arts curricula. The results of the research review show that students are motivated to read when they choose their own reading material and can comprehend the material after engaging in collaborative, meaningful discussion of the text with peers. The project includes instructional frameworks, lesson plans for after-reading activities, and book selections for three rounds ofliterature circles

Exploring the treatment of epilepsy through intrahippocampal GABA modulation with an HSVvector expressing GAD67

Articlehttp://deepblue.lib.umich.edu/bitstream/2027.42/96990/1/UMURF-Issue06_2009-MMooney.pd

Which variables are associated with blood glucose levels outside the target range in surgical critically ill patients? A retrospective observational study

<p>Abstract</p> <p>Background</p> <p>The aim of the present study is to determine the variables affecting blood glucose concentrations outside the target range of 80 and 150 mg/dl in critically ill surgical patients.</p> <p>Methods</p> <p>All critically ill surgical patients admitted to a university ICU, from 01/2007 to 12/2008, were surveyed daily using computer assistance with respect to minimal and maximal daily blood glucose concentrations, application of insulin and demographic/clinical variables. Multiple logistic regression for clustered data with backward elimination was performed to identify variables strongly associated with blood glucose concentrations < 80 mg/dl or ≥ 150 mg/dl in 804 patients with an ICU stay > 72 hours.</p> <p>Results</p> <p>Application of insulin (odds ratio (OR) 2.1, with corresponding 95% confidence interval (CI) 1.7; 2.6), noradrenaline (OR 1.4, 95% CI 1.2 - 1.8) or steroids (1.3, 1.003 - 1.7), and age (per year) (1.02, 1.01 - 1.03) were associated with an increased risk of blood glucose concentrations < 80 mg/dl. In analogy, application of insulin (OR 2.4, 95% CI 2.0 - 2.7), noradrenaline (1.4, 1.2 - 1.6) or steroids (1.4, 1.2 - 1.7), severe sepsis (1.2, 1.1 - 1.4), neurosurgery (OR 1.0) compared to abdominal, vascular and trauma surgery, and age (per year) (1.01, 1.01 - 1.02), were associated with an increased risk of blood glucose concentrations ≥ 150 mg/dl.</p> <p>Conclusions</p> <p>Critically ill surgical patients are at an increased risk for fluctuating blood glucose concentrations ranging < 80 mg/dl or ≥ 150 mg/dl in particular if they are of advanced age and require administration of insulin, noradrenaline, and/or steroids. Patients who underwent neurosurgery and/or presented with severe sepsis/shock are those in particular at risk for blood glucose concentrations ≥ 150 mg/dl.</p

Molecular Microbiology in Clinical Practice: Current and Future Applications

Technological advances have yielded new molecular biology-based methods for the diagnosis of infectious diseases.  The newest and most powerful molecular diagnostic tests are available at regional and national reference laboratories, as well as at specialized centers that are certified to conduct metagenomic testing.  Metagenomic assays utilize advances in DNA extraction technology, DNA sequence library construction, high throughput DNA sequencing and automated data analysis to identify millions of individual strands of DNA extracted from clinical samples.  At present, metagenomic assays are only possible at a small number of special research, academic and commercial laboratories.  Continued research in human and pathogen genomic organization and host-pathogen interactions, represent important future goals that will maximize the information obtained from metagenomic assays.  To illustrate the power and limitations of metagenomics, we report on a previously healthy 27 year old woman with work related exposure to ill animals, and who developed a rapidly progressive, severe diffuse interstitial pneumonitis that ultimately ended in the need for a double lung transplant.   Metagenomic testing on DNA extracted from pleural fluid and nasopharyngeal swabs demonstrated the presence of expected normal bacterial flora along with some unexpected herpesvirus and non-HIV retroviral elements integrated into the patients DNA.  Although no specific pathogen was ultimately identified to explain this patient’s severe disease, the sample preparation and data analysis methods detailed herein illustrate the powerful benefits and limitations of metagenomic testing

Inhalts- und Nebenbestimmungen in Genehmigungen von Windenergieanlagen

Following a legal and economic evaluation of all wind turbine autorisations issued in Baden-Württemberg between 2012 and 2017, this working aid shows – in addition to the requirements to be observed – optimal text modules for side regulations in all relevant legal areas. It thus offers an indispensable working aid in the important field of the legally secure expansion of wind energy – this also beyond the borders of the administrative practice in Baden-Württemberg.PublishedNach rechtlicher und betriebswirtschaftlicher Auswertung aller zwischen 2012 und 2017 in Baden-Württemberg erteilten Windenergieanlagen-Genehmigungen zeigt der vorliegende Band – neben den zu beachtenden Anforderungen – optimale Textbausteine für Inhalts- und Nebenbestimmungen auf allen relevanten Rechtsgebieten auf. Der Band bietet damit eine unerlässliche Arbeitshilfe auf dem wichtigen Gebiet des rechtssicheren Ausbaus der Windenergie – dies auch über die Grenzen der baden-württembergischen Verwaltungspraxis hinaus

Exceptional sequence of severe thunderstorms and related flash floods in May and June 2016 in Germany – Part 1: Meteorological background

Abstract. During a 15-day episode from 26 May to 9 June 2016, Germany was affected by an exceptionally large number of severe thunderstorms. Heavy rainfall, related flash floods and creek flooding, hail, and tornadoes caused substantial losses running into billions of euros (EUR). This paper analyzes the key features of the severe thunderstorm episode using extreme value statistics, an aggregated precipitation severity index, and two different objective weather-type classification schemes. It is shown that the thunderstorm episode was caused by the interaction of high moisture content, low thermal stability, weak wind speed, and large-scale lifting by surface lows, persisting over almost 2 weeks due to atmospheric blocking. For the long-term assessment of the recent thunderstorm episode, we draw comparisons to a 55-year period (1960–2014) regarding clusters of convective days with variable length (2–15 days) based on precipitation severity, convection-favoring weather patterns, and compound events with low stability and weak flow. It is found that clusters with more than 8 consecutive convective days are very rare. For example, a 10-day cluster with convective weather patterns prevailing during the recent thunderstorm episode has a probability of less than 1 %

The DESI Experiment, a whitepaper for Snowmass 2013

The Dark Energy Spectroscopic Instrument (DESI) is a massively multiplexed fiber-fed spectrograph that will make the next major advance in dark energy in the timeframe 2018-2022. On the Mayall telescope, DESI will obtain spectra and redshifts for at least 18 million emission-line galaxies, 4 million luminous red galaxies and 3 million quasi-stellar objects, in order to: probe the effects of dark energy on the expansion history using baryon acoustic oscillations (BAO), measure the gravitational growth history through redshift-space distortions, measure the sum of neutrino masses, and investigate the signatures of primordial inflation. The resulting 3-D galaxy maps at z<2 and Lyman-alpha forest at z>2 will make 1%-level measurements of the distance scale in 35 redshift bins, thus providing unprecedented constraints on cosmological models.Comment: 14 pages, 4 figures, a White Paper for Snowmass 201

Medical Students\u27 Experiences and Outcomes Using a Virtual Human Simulation to Improve Communication Skills: Mixed Methods Study

Background: Attending to the wide range of communication behaviors that convey empathy is an important but often underemphasized concept to reduce errors in care, improve patient satisfaction, and improve cancer patient outcomes. A virtual human (VH)–based simulation, MPathic-VR, was developed to train health care providers in empathic communication with patients and in interprofessional settings and evaluated through a randomized controlled trial. Objective: This mixed methods study aimed to investigate the differential effects of a VH-based simulation developed to train health care providers in empathic patient-provider and interprofessional communication. Methods: We employed a mixed methods intervention design, involving a comparison of 2 quantitative measures—MPathic-VR–calculated scores and the objective structured clinical exam (OSCE) scores—with qualitative reflections by medical students about their experiences. This paper is a secondary, focused analysis of intervention arm data from the larger trial. Students at 3 medical schools in the United States (n=206) received simulation to improve empathic communication skills. We conducted analysis of variance, thematic text analysis, and merging mixed methods analysis. Results: OSCE scores were significantly improved for learners in the intervention group (mean 0.806, SD 0.201) compared with the control group (mean 0.752, SD 0.198; F1,414=6.09; P=.01). Qualitative analysis revealed 3 major positive themes for the MPathic-VR group learners: gaining useful communication skills, learning awareness of nonverbal skills in addition to verbal skills, and feeling motivated to learn more about communication. Finally, the results of the mixed methods analysis indicated that most of the variation between high, middle, and lower performers was noted about nonverbal behaviors. Medium and high OSCE scorers most often commented on the importance of nonverbal communication. Themes of motivation to learn about communication were only present in middle and high scorers. Conclusions: VHs are a promising strategy for improving empathic communication in health care. Higher performers seemed most engaged to learn, particularly nonverbal skills

Use of a regional wall motion score to enhance risk stratification of patients receiving an implantable cardioverter-defibrillator

AbstractObjectives. We postulated that preoperative assessment of both regional wall motion and left ventricular ejection fraction would serve as an accurate prognostic indicator of long-term cardiac mortality and functional outcome in patients treated with an implantable cardioverter-defibrillator.Background. Long-term cardiac mortality has remained high in patients receiving an implantable cardioverter-defibrillator. The ability to risk stratify patients before defibrillator implantation is becoming increasingly important from a medical and economic standpoint.Methods. The hypothesis was retrospectively tested in 74 patients who had received an implantable cardioverterdefibrillator. Left ventricular ejection fraction and regional wall motion score, derived from centerline chord motion analysis, were calculated for each patient from the preoperative right anterior oblique contrast ventriculogram. Wall motion score was the only significant independent predictor of long-term cardiac mortality and functional status by multivariate analysis because of its enhanced prognostic capability in patients with an ejection fraction in the critical range of 30% to 40%.Results. Patients with an ejection fraction >40% had a 3-year cardiac mortality rate of 0% compared with 25% for those with an ejection fraction of 30% to 40% and 48% for those with an ejection fraction <30% (p < 0.05). Similarly, 75% of patients with an ejection fraction >40% were in New York Heart Association functional class I or II during long-term follow-up compared with 59% of those with an ejection fraction 30% to 40% and 29% of those with an ejection fraction <30%. Among patients with an ejection fraction of 30% to 40%, those with a wall motion score >16% had a 3-year cardiac mortality rate of 0% compared with 71% of those with a wall motion score ≤ 16% (p = 0.002). In addition, 86% of patients with a wall motion score >16% were in functional class I or II during long-term follow-up compared with 13% of those with a wall motion score ≤16% (p = 0.001).Conclusions. Long-term cardiac mortality and functional outcome in patients receiving an implantable cardioverterdefibrillator can be predicted if the left ventricular ejection fraction and regional wall motion score are measured preoperatively

Initial Construct Validity Evidence of a Virtual Human Application for Competency Assessment in Breaking Bad News to a Cancer Patient

Background: Despite interest in using virtual humans (VHs) for assessing health care communication, evidence of validity is limited. We evaluated the validity of a VH application, MPathic-VR, for assessing performance-based competence in breaking bad news (BBN) to a VH patient. Methods: We used a two-group quasi-experimental design, with residents participating in a 3-hour seminar on BBN. Group A (n=15) completed the VH simulation before and after the seminar, and Group B (n=12) completed the VH simulation only after the BBN seminar to avoid the possibility that testing alone affected performance. Pre-and postseminar differences for Group A were analyzed with a paired t-test, and comparisons between Groups A and B were analyzed with an independent t-test. Results: Compared to the preseminar result, Group A\u27s postseminar scores improved significantly, indicating that the VH program was sensitive to differences in assessing performance-based competence in BBN. Postseminar scores of Group A and Group B were not significantly different, indicating that both groups performed similarly on the VH program. Conclusion: Improved pre-post scores demonstrate acquisition of skills in BBN to a VH patient. Pretest sensitization did not appear to influence posttest assessment. These results provide initial construct validity evidence that the VH program is effective for assessing BBN performance-based communication competence