Exploring Standardized Patients’ Perspectives on Working with Medical Students

Little is known about how working with emerging medical professionals affects Standardized Patients’ (SPs’) professional identities, yet understanding the SP-medical student interaction could be useful for screening SPs, supporting SP professional identity formation, and bridging the SP and medical student cultures. This project provides the unique perspective of SPs involved in the growth of medical students into physicians. Qualitative methods were used to understand the SPs’ perspectives. Two researchers, without evaluative relationships with the SPs, conducted 2 one-hour focus group interviews (n=3; n=9) using a semi-structured interview protocol. Interviews were audio-recorded and transcribed verbatim. Three researchers independently analyzed the transcripts to identify clusters of meaning and codes. Codes identified by consensus and analysis continued until saturation was reached, followed by identification of categories and themes. To ensure credibility and trustworthiness of the results, investigators used triangulation of methods and researchers, prolonged engagement with the data, and presentation of thick rich descriptions as evidence of each theme. A number of themes were identified in these focus group interviews. SPs experienced a transformation of purpose and the emergence of a new professional identity, including genuine professional, guide, teacher, counselor and surrogate parent. They discovered personal meaning and mutuality in their relationships with students, like the satisfaction of helping others, benefiting society, and growing personally. SPs found themselves reacting to student behaviors in a variety of ways including admiration, dislike, surprise, and discomfort. Finally, SPs confronted challenges in moving between their simulated and real selves. This analysis provided insights into transformations SPs underwent as a result their work. It revealed a self-actualization process in which SPs experienced an emergence of new roles and a discovery of new meaning in their relationships similar to the professional identity formation process of students. Understanding this process may prove useful to SP educators in knowing how to best nurture identity, train SPS, reinforce job meaningfulness and increase SP recruitment and retention. SP perspectives about their students’ behaviors may be useful to SP educators in acclimatizing them to the simulation process

Biases in, and corrections to, KSB shear measurements

We analyse the KSB method to estimate gravitational shear from surface-brightness moments of small and noisy galaxy images. We identify three potentially problematic assumptions. These are: (1) While gravitational shear must be estimated from averaged galaxy images, KSB derives a shear estimate from each individual image and then takes the average. Since the two operations do not commute, KSB gives biased results. (2) KSB implicitly assumes that galaxy ellipticities are small, while weak gravitational lensing assures only that the change in ellipticity due to the shear is small. (3) KSB does not invert the convolution with the point-spread function, but gives an approximate PSF correction which - even for a circular PSF - holds only in the limit of circular sources. The effects of assumptions (2) and (3) partially counter-act in a way dependent on the width of the weight function and of the PSF. We quantitatively demonstrate the biases due to all assumptions, extend the KSB approach consistently to third order in the shear and ellipticity and show that this extension lowers the biases substantially. The issue of proper PSF deconvolution will be addressed in a forthcoming paper.Comment: 12 pages, 10 figures, MNRAS submitte

Age and Body Satisfaction Predict Diet Adherence in Adolescents with Inflammatory Bowel Disease

The aim of the current study was to determine whether age and body satisfaction predict dietary adherence in adolescents with Inflammatory Bowel Disease (IBD), and whether older females are less adherent than younger males and females. Forty-four participants aged 10-21 with IBD were recruited. Participants provided informed consent and demographics. Body satisfaction was measured by a questionnaire and a task in which participants selected their current and ideal body image out of silhouettes depicting bodies ranging from underweight to obese. Adherence was measured by marking a 100mm visual analog scale, the 1-week completion of a dietary log, and a questionnaire evaluating coping strategies used for overcoming obstacles to dietary adherence. Age was related to dietary adherence, with younger children being more likely to adhere. Participants more satisfied with their body reported better dietary adherence. Findings remained consistent across multiple measures of body satisfaction and adherence. Healthcare providers and parents should be informed of these findings in order to improve adherence

Hip fracture outcomes in patients with COPD

Hip fractures are common in patients with COPD and contemporary outcome data is needed. Patients admitted with a hip fracture to one acute trust (2010-2015) were assessed prospectively (UK National Hip Fracture Database audit) and mortality data collected. Of the 4020 patients, 16.2% had a recorded COPD diagnosis. Mortality was significantly greater in patients with COPD compared to non-COPD: 30-days (12.6% vs 7.8%) and 1-year (35.3% vs 25.3%), both p[less than] 0.001 and remained significant after adjustment (aOR at 1 year 1.44 95% CI1.18 -1.76). There is further excess mortality following a hip fracture in those with COPD

Active Referral Intervention following Fragility Fractures Leads to Enhanced Osteoporosis Follow-Up Care

At one major urban academic medical center, patients aged 50 years and older with fragility fractures were identified and scheduled or assisted in referral into osteoporosis medical management appointments. We evaluated the efficacy of an active intervention program at overcoming the logistical barriers and improving proper osteoporosis follow-up for persons who have sustained a fragility fracture. Of 681 patients treated for defined fractures, 168 were eligible and consented for the study of fragility fractures. Of those enrolled, 91 (54.2%) had appropriate osteoporosis follow-up on initial interview, and overall 120 (71.4%) had successful osteoporosis follow-up following our active intervention. Seventy patients (41.7%) were deemed to have no osteoporosis follow-up, and, of these, 48 were successfully referred to a scheduling coordinator. The scheduling coordinator was able to contact 37 (77%) patients to schedule proper follow-up, and, of these, 29 (78.4%) confirmed receiving an appropriate follow-up appointment. Active intervention and assisted scheduling for patients with recent fragility fractures improved the self-reported rate of osteoporosis follow-up from 54.2% to 71.4%

Observational Results of a Multi-Telescope Campaign in Search of Interstellar Urea [(NH2_2)2_2CO]

In this paper, we present the results of an observational search for gas phase urea [(NH$_2$)$_2$CO] observed towards the Sgr B2(N-LMH) region. We show data covering urea transitions from $\sim$100 GHz to 250 GHz from five different observational facilities: BIMA, CARMA, the NRAO 12 m telescope, the IRAM 30 m telescope, and SEST. The results show that the features ascribed to urea can be reproduced across the entire observed bandwidth and all facilities by best fit column density, temperature, and source size parameters which vary by less than a factor of 2 between observations merely by adjusting for telescope-specific parameters. Interferometric observations show that the emission arising from these transitions is cospatial and compact, consistent with the derived source sizes and emission from a single species. Despite this evidence, the spectral complexity, both of (NH$_2$)$_2$CO and of Sgr B2(N), makes the definitive identification of this molecule challenging. We present observational spectra, laboratory data, and models, and discuss our results in the context of a possible molecular detection of urea.Comment: 38 pages, 9 Figures, accepted in the Astrophysical Journa