Faculty verbal evaluations reveal strategies used to promote medical student performance

Background: Preceptors rarely follow medical students’ developing clinical performance over time and across disciplines. This study analyzes preceptors’ descriptions of longitudinal integrated clerkship (LIC) students’ clinical development and their identification of strategies to guide students’ progress. Methods: We used a common evaluation framework, reporter-interpreter-manager-educator, to guide multidisciplinary LIC preceptors’ discussions of students’ progress. We conducted thematic analysis of transcripts from preceptors’ (seven longitudinal ambulatory preceptors per student) quarterly group discussions of 15 students’ performance over one year. Results: All students’ clinical development progressed, although most experienced obstacles. Lack of structure in the history and physical exam commonly obstructed progression. Preceptors used templates for data gathering, and modeling or experiences in the inpatient setting to provide time and solidify structure. To advance students’ knowledge acquisition, many preceptors identified focused learning topics with their students; to promote application of knowledge, preceptors used reasoning strategies to teach the steps involved in synthesizing clinical data. Preceptors shared accountability for helping students advance as the LIC allowed them to follow students’ response to teaching strategies. Discussion: These results depict preceptors’ perceptions of LIC students’ developmental continuum and illustrate how multidisciplinary preceptors can use a common evaluation framework to identify strategies to improve performance and follow students’ performance longitudinally

Effects of traumatic brain injury and posttraumatic stress disorder on Alzheimer's disease in veterans, using the Alzheimer's Disease Neuroimaging Initiative

Both traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are common problems resulting from military service, and both have been associated with increased risk of cognitive decline and dementia resulting from Alzheimer's disease (AD) or other causes. This study aims to use imaging techniques and biomarker analysis to determine whether traumatic brain injury (TBI) and/or PTSD resulting from combat or other traumas increase the risk for AD and decrease cognitive reserve in Veteran subjects, after accounting for age. Using military and Department of Veterans Affairs records, 65 Vietnam War veterans with a history of moderate or severe TBI with or without PTSD, 65 with ongoing PTSD without TBI, and 65 control subjects are being enrolled in this study at 19 sites. The study aims to select subject groups that are comparable in age, gender, ethnicity, and education. Subjects with mild cognitive impairment (MCI) or dementia are being excluded. However, a new study just beginning, and similar in size, will study subjects with TBI, subjects with PTSD, and control subjects with MCI. Baseline measurements of cognition, function, blood, and cerebrospinal fluid biomarkers; magnetic resonance images (structural, diffusion tensor, and resting state blood-level oxygen dependent (BOLD) functional magnetic resonance imaging); and amyloid positron emission tomographic (PET) images with florbetapir are being obtained. One-year follow-up measurements will be collected for most of the baseline procedures, with the exception of the lumbar puncture, the PET imaging, and apolipoprotein E genotyping. To date, 19 subjects with TBI only, 46 with PTSD only, and 15 with TBI and PTSD have been recruited and referred to 13 clinics to undergo the study protocol. It is expected that cohorts will be fully recruited by October 2014. This study is a first step toward the design and statistical powering of an AD prevention trial using at-risk veterans as subjects, and provides the basis for a larger, more comprehensive study of dementia risk factors in veterans

Evidence-based guidelines for the pharmacological treatment of postmenopausal osteoporosis: a consensus document by the Belgian Bone Club

Several drugs are available for the management of postmenopausal osteoporosis. This may, in daily practice, confuse the clinician. This manuscript offers an evidence-based update of previous treatment guidelines, with a critical assessment of the currently available efficacy data on all new chemical entities which were granted a marketing authorization. Osteoporosis is widely recognized as a major public health concern. The availability of new therapeutic agents makes clinical decision-making in osteoporosis more complex. Nation-specific guidelines are needed to take into consideration the specificities of each and every health care environment. The present manuscript is the result of a National Consensus, based on a systematic review and a critical appraisal of the currently available literature. It offers an evidence-based update of previous treatment guidelines, with the aim of providing clinicians with an unbiased assessment of osteoporosis treatment effect

Of threats and costs: a game-theoretic approach to security risk management

Security is one of the main concerns in current telecommunication net- works: the service providers and individual users have to protect themselves against attacks, and to this end a careful analysis of their optimal strategies is of essential importance. Indeed, attackers and defenders are typically agents trying strategically to design the most important damages and the most secure use of the resources, re- spectively, and the natural modelling framework of these interactions is that of non- cooperative game theory. This chapter aims at providing a comprehensive review of game-theoretic aspects of security. We first describe the basics on game theory through simple security problems, and then present and discuss some specific prob- lems in more detail. Finally, we also deal with security economics, focusing on the selfish relationships between customers and providers as well as between competing providers, which represents another important aspect of our non-standard approach towards security risk assessement

Fourier Analysis for Demand Forecasting in a Fashion Company

In the fashion industry, demand forecasting is particularly complex: companies operate with a large variety of short lifecycle products, deeply influenced by seasonal sales, promotional events, weather conditions, advertising and marketing campaigns, on top of festivities and socio-economic factors. At the same time, shelf-out-of-stock phenomena must be avoided at all costs. Given the strong seasonal nature of the products that characterize the fashion sector, this paper aims to highlight how the Fourier method can represent an easy and more effective forecasting method compared to other widespread heuristics normally used. For this purpose, a comparison between the fast Fourier transform algorithm and another two techniques based on moving average and exponential smoothing was carried out on a set of 4-year historical sales data of a €60+ million turnover medium- to large-sized Italian fashion company, which operates in the women's textiles apparel and clothing sectors. The entire analysis was performed on a common spreadsheet, in order to demonstrate that accurate results exploiting advanced numerical computation techniques can be carried out without necessarily using expensive software

Using citizen science to monitor Bombus populations in the UK: nesting ecology and relative abundance in the urban environment

Citizen science can provide a valuable tool for collecting large quantities of ecological data over a larger geographic area than would otherwise be possible. Here, data were collected on 1,022 bumblebee nests by means of a public survey in which participants were asked to record attributes of bumblebee nests discovered in their gardens. All commonly reported species appeared to be generalist in their nest site selection and though species-specific differences in nest site choice were evident, there was a high degree of overlap in nesting habitat between most species. There was little evidence supporting the hypothesis that bumblebees tend to nest in the same site in consecutive years. A comparison of the contributions made by different species to the total nests reported in this and previous similar surveys suggests that the common bumblebee species Bombus pascuorum may have declined over the past 20 years relative to other species, comprising ~21% of colonies discovered in a survey conducted in 1989–1991, but just 8–9% of colonies in 2007–2009. This was accompanied by a reduction in the proportion of nests on the ground surface (the preferred position of this species). This is the first quantitative evidence of potential declines in the one of the UK’s ‘big six’ common bumblebee species