The Clinical Reasoning Assessment Tool for Learning from Standardized Patient Experiences: A Pilot Study

Purpose: Clinical reasoning (CR) is the ability to integrate the knowledge of diagnoses with the use of supporting theories to create effective, client-centered interventions. One means of teaching CR to rehabilitation students is using standardized patient (SP) experiences. The relationship between faculty and student CR ratings after SP experiences has not been researched. The purpose of the study was to determine if there would be correlations between physical therapy (PT) and occupational therapy (OT) student and faculty ratings of CR skills after an SP experience. Method: The Clinical Reasoning Assessment Tool (CRAT) was used by students to self-reflect on their CR performance after an SP experience and compared to their respective faculty ratings. The CRAT includes three subsections: content knowledge, procedural knowledge, and conceptual reasoning, each with a visual analog scale. Correlations between students’ self-assessment of CR and faculty reviews were analyzed using Spearman’s rho correlations. Results: Seventeen PT and seventeen OT students participated. Spearman’s rho correlation coefficients for the PT students and their faculty were: content knowledge (r=.180; p=.488), procedural knowledge (r=.697; p=.002), and conceptual reasoning (r=.258; p=.317). Spearman’s rho correlation coefficients for the OT students and their faculty were: content knowledge (r=.103; p=.693), procedural knowledge (r=.676; p=.003), and conceptual reasoning (r=.505; p=.039). Conclusions: Neither PT nor OT student ratings was a statistically significant correlation in content knowledge ratings in relation to respective faculty ratings. Both PT and OT student procedural knowledge rating correlations with faculty were strong and statistically significant. PT student and faculty ratings were not significantly correlated in conceptual reasoning compared to faculty; however, OT students and faculty ratings were strong, had positive correlations, and were statistically significant. Further research is needed to assess students’ CR development longitudinally across curricula

Observation of an optical spring with a beam splitter

We present the experimental observation of an optical spring without the use of an optical cavity. The optical spring is produced by interference at a beam splitter and, in principle, does not have the damping force associated with optical springs created in detuned cavities. The experiment consists of a Michelson–Sagnac interferometer (with no recycling cavities) with a partially reflective GaAs microresonator as the beam splitter that produces the optical spring. Our experimental measurements at input powers of up to 360 mW show the shift of the optical spring frequency as a function of power and are in excellent agreement with theoretical predictions. In addition, we show that the optical spring is able to keep the interferometer stable and locked without the use of external feedback

Evaluation of stress and social skills in the academic experience of medical students of a Rio de Janeiro university

Studies done in several countries have show that medical students are exposed to many situations that cause stress. The student’s lack of preparation to deal with these situations can have important repercussions in regard to his/her performance, health and psychological and social well-being. Besides this, research has shown that deficiencies in social skills can contribute to the development of stress. This study evaluated sources of stress that exist within the medical course, as well as the relation between the levels of stress and social skills of the students. The sample consisted of 178 students (105 women and 73 men) from the first to the sixth level of medicine. The questionnaire to evaluate stressors, the Stress Symptom Inventory compiled by Lipp (ISSL) and Social Skills Inventory (IHS), revealed 7 sources of stress most quoted by the students. Besides this, the majority of the students are in a phase of resistance to stress. Deficiency in social skills is related to stress in this population and this is one more factor added to other sources of stress. It was concluded that the academic experience of this sample favors stress and to which low levels of social skills is related. The results obtained in this study can be used to elaborate projects which give psychological support to medical students and improvement to their academic development as well. It is suggested that this research be reproduced in other schools of Medicine so as to make possible a comparison between the obtained results, that will confirm, add or even oppose to the results of this study.Keywords: stress in students of medicine; social skills; academic stress.Estudos realizados em vários países indicam que estudantes de medicina estão expostos durante sua formação acadêmica a diversas situações geradoras de estresse. O despreparo do estudante para lidar com estas situações pode trazer repercussões importantes em seu desempenho acadêmico, em sua saúde e em seu bem-estar psicossocial. Além disso, pesquisas têm mostrado que deficiências em habilidades sociais podem contribuir para o desenvolvimento do estresse. Este estudo avaliou as fontes de estresse existentes no curso de medicina, assim como a relação entre os níveis de estresse e de habilidades sociais nos estudantes. A amostra constituiu-se de 178 alunos (105 mulheres e 73 homens) do primeiro ao sexto ano de medicina. O questionário para avaliação de estressores, o Inventário de Sintomas de Stress para Adultos de Lipp (ISSL) e o Inventário de Habilidades Sociais (IHS) revelaram 7 fontes de estresse mais apontadas pelos estudantes. Além disso, a maioria dos alunos encontra-se na fase de resistência ao estresse. Deficiências em habilidades sociais estão relacionadas ao estresse nesta população, sendo mais um fator somado às outras fontes estressoras. Conclui-se que a experiência acadêmica dessa amostra favorece o estresse e que níveis mais baixos de habilidades sociais estão relacionados à presença de estresse. Os dados obtidos neste estudo podem ser utilizados na elaboração de projetos de apoio psicológico para estudantes de medicina, bem como na melhoria do desenvolvimento acadêmico dos mesmos. Sugere-se que esta pesquisa seja replicada em outras faculdades de medicina para possibilitar uma comparação entre os resultados obtidos, os quais poderão confirmar, ampliar ou mesmo refutar os achados deste estudo.Palavras-chave: Estresse em estudantes de medicina; habilidades sociais; estresse acadêmico.

A influência da raiva e da empatia sobre a satisfação conjugal

O estudo avaliou a influência da raiva e da expressão de empatia no casamento sobre a satisfação conjugal. Participaram da pesquisa 120 pessoas casadas, com idades de 25 a 76 anos. Para avaliação foram utilizados três instrumentos de autoinforme: Questionário de Empatia Conjugal; Escala de Satisfação Conjugal e Inventário de Expressão de Raiva como Estado e Traço.Os resultados revelaram que houve correlação positiva entre empatia conjugal e satisfação conjugal (r = 0,48; p 0,001), enquanto a raiva manteve correlação negativa com a satisfação conjugal (r = -0,30; p 0,01). As análises de regressão múltipla indicaram que a expressão de empatia aumenta e a raiva disfuncional diminui a satisfação conjugal. Verificou-se também a influência das variáveis idade, sexo, tempo de casamento e número de filhos sobre a satisfação no casamento. Conforme os principais resultados, conclui-se que a empatia e a raiva são fatores que influenciam a satisfação conjugal

An evaluation of the relationships between empathy and marriage satisfaction: a preliminary study

O estudo avaliou as relações existentes entre a empatia e a satisfação conjugal. Participaram da pesquisa 120 indivíduos casados, alunos e funcionários de vários Institutos e Faculdades da Universidade do Estado do Rio de Janeiro, com média de idade de 38,99 anos. Os participantes responderam a um Questionário de Empatia Conjugal (QEC), ao Índice de Reatividade Interpessoal (IRI) (Davis, 1983) e à Medida de Satisfação Conjugal (Dela Coleta, 1989). Os dados obtidos com os instrumentos acima especificados revelaram um nível significativamente mais elevado de satisfação no casamento entre os participantes que possuíam parceiros com níveis mais elevados de empatia conjugal. A avaliação das correlações entre as três medidas apontou correlações estatisticamente significantes entre as escalas: IRI e Satisfação Conjugal (r=0,28, p<0,01); IRI e QEC (r=0,25, p<0,01); e entre Satisfação Conjugal e QEC (r=0,74, p<0,001). O coeficiente alfa elevado (0,95) encontrado na medida QEC permite recomendar sua utilização na clínica e em pesquisa.   Palavras-chave: empatia; satisfação conjugal; avaliação.The study evaluated the relationships between the empathy and marriage satisfaction. A group of 120 married adults (M = 38,99 years old), students and employees from several institutes and colleges of the Rio de Janeiro State University participated in the study. Participants completed the Marriage Empathy Questionnaire (MEQ), the Davis Interpersonal Reactivity Index (IRI) (Davis, 1983) and the Marriage Satisfaction Scale (Dela Coleta, 1989). The data obtained from the above mentioned instruments showed that participants who reported that their partners had higher levels of marriage empathy also presented higher levels of satisfaction in the marriage. Analyses identified statistically significant correlations between the three measures: IRI and Marriage Satisfaction (r=0,28, p < 0,01); IRI and MEQ (r=0,25, p < 0,01); and Marriage Satisfaction and MEQ (r=0,74, p < 0,001). The high Cronbach’s alpha coefficient (0,95) found in the MEQ measure allows us to recommend its use in clinical practice and in research.   Keywords: empathy; marriage satisfaction; evaluation

No Effect of Commercial Cognitive Training on Brain Activity, Choice Behavior, or Cognitive Performance

Increased preference for immediate over delayed rewards and for risky over certain rewards has been associated with unhealthy behavioral choices. Motivated by evidence that enhanced cognitive control can shift choice behavior away from immediate and risky rewards, we tested whether training executive cognitive function could influence choice behavior and brain responses. In this randomized controlled trial, 128 young adults (71 male, 57 female) participated in 10 weeks of training with either a commercial web-based cognitive training program or web-based video games that do not specifically target executive function or adapt the level of difficulty throughout training. Pretraining and post-training, participants completed cognitive assessments and functional magnetic resonance imaging during performance of the following validated decision-making tasks: delay discounting (choices between smaller rewards now vs larger rewards in the future) and risk sensitivity (choices between larger riskier rewards vs smaller certain rewards). Contrary to our hypothesis, we found no evidence that cognitive training influences neural activity during decision-making; nor did we find effects of cognitive training on measures of delay discounting or risk sensitivity. Participants in the commercial training condition improved with practice on the specific tasks they performed during training, but participants in both conditions showed similar improvement on standardized cognitive measures over time. Moreover, the degree of improvement was comparable to that observed in individuals who were reassessed without any training whatsoever. Commercial adaptive cognitive training appears to have no benefits in healthy young adults above those of standard video games for measures of brain activity, choice behavior, or cognitive performance. SIGNIFICANCE STATEMENT Engagement of neural regions and circuits important in executive cognitive function can bias behavioral choices away from immediate rewards. Activity in these regions may be enhanced through adaptive cognitive training. Commercial brain training programs claim to improve a broad range of mental processes; however, evidence for transfer beyond trained tasks is mixed. We undertook the first randomized controlled trial of the effects of commercial adaptive cognitive training (Lumosity) on neural activity and decision-making in young adults (N = 128) compared with an active control (playing on-line video games). We found no evidence for relative benefits of cognitive training with respect to changes in decision-making behavior or brain response, or for cognitive task performance beyond those specifically trained

Subtype Specificity of Genetic Loci Associated With Stroke in 16 664 Cases and 32 792 Controls

Background: Genome-wide association studies have identified multiple loci associated with stroke. However, the specific stroke subtypes affected, and whether loci influence both ischemic and hemorrhagic stroke, remains unknown. For loci associated with stroke, we aimed to infer the combination of stroke subtypes likely to be affected, and in doing so assess the extent to which such loci have homogeneous effects across stroke subtypes. Methods: We performed Bayesian multinomial regression in 16 664 stroke cases and 32 792 controls of European ancestry to determine the most likely combination of stroke subtypes affected for loci with published genome-wide stroke associations, using model selection. Cases were subtyped under 2 commonly used stroke classification systems, TOAST (Trial of Org 10172 Acute Stroke Treatment) and causative classification of stroke. All individuals had genotypes imputed to the Haplotype Reference Consortium 1.1 Panel. Results: Sixteen loci were considered for analysis. Seven loci influenced both hemorrhagic and ischemic stroke, 3 of which influenced ischemic and hemorrhagic subtypes under both TOAST and causative classification of stroke. Under causative classification of stroke, 4 loci influenced both small vessel stroke and intracerebral hemorrhage. An EDNRA locus demonstrated opposing effects on ischemic and hemorrhagic stroke. No loci were predicted to influence all stroke subtypes in the same direction, and only one locus (12q24) was predicted to influence all ischemic stroke subtypes. Conclusions: Heterogeneity in the influence of stroke-associated loci on stroke subtypes is pervasive, reflecting differing causal pathways. However, overlap exists between hemorrhagic and ischemic stroke, which may reflect shared pathobiology predisposing to small vessel arteriopathy. Stroke is a complex, heterogeneous disorder requiring tailored analytic strategies to decipher genetic mechanisms

Subtype Specificity of Genetic Loci Associated With Stroke in 16 664 Cases and 32 792 Controls

Background: Genome-wide association studies have identified multiple loci associated with stroke. However, the specific stroke subtypes affected, and whether loci influence both ischemic and hemorrhagic stroke, remains unknown. For loci associated with stroke, we aimed to infer the combination of stroke subtypes likely to be affected, and in doing so assess the extent to which such loci have homogeneous effects across stroke subtypes. Methods: We performed Bayesian multinomial regression in 16 664 stroke cases and 32 792 controls of European ancestry to determine the most likely combination of stroke subtypes affected for loci with published genome-wide stroke associations, using model selection. Cases were subtyped under 2 commonly used stroke classification systems, TOAST (Trial of Org 10172 Acute Stroke Treatment) and causative classification of stroke. All individuals had genotypes imputed to the Haplotype Reference Consortium 1.1 Panel. Results: Sixteen loci were considered for analysis. Seven loci influenced both hemorrhagic and ischemic stroke, 3 of which influenced ischemic and hemorrhagic subtypes under both TOAST and causative classification of stroke. Under causative classification of stroke, 4 loci influenced both small vessel stroke and intracerebral hemorrhage. An EDNRA locus demonstrated opposing effects on ischemic and hemorrhagic stroke. No loci were predicted to influence all stroke subtypes in the same direction, and only one locus (12q24) was predicted to influence all ischemic stroke subtypes. Conclusions: Heterogeneity in the influence of stroke-associated loci on stroke subtypes is pervasive, reflecting differing causal pathways. However, overlap exists between hemorrhagic and ischemic stroke, which may reflect shared pathobiology predisposing to small vessel arteriopathy. Stroke is a complex, heterogeneous disorder requiring tailored analytic strategies to decipher genetic mechanisms

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure

Immunological Sex Differences in Socially Promiscuous African Ground Squirrels

Differences in how males and females respond to foreign antigens are common across taxa. Such sexual differences in the immune system are predicted to be greater in species with high promiscuity and sociality as these factors increase the likelihood of disease transmission. Intense sperm competition is thought to further this sexual dichotomy as increased investment in spermatogenesis likely incurs additional immunological costs. Xerus inauris, a ground squirrel found throughout southern Africa, is extremely social and promiscuous with one of the highest male reproductive investments among rodents. These life-history attributes suggest males and females should demonstrate a large dichotomy in immunity. Contrary to our prediction, we found no difference in spleen mass between the sexes. However, we did find significant biases in leukocyte types and red blood cell counts, possibly reflecting responses to parasite types. Among males, we predicted greater investments in spermatogenesis would result in reduced immunological investments. We found a negative association between testes and spleen size and a positive relationship between testes and number of lice suggesting trade-offs in reproductive investment possibly due to the costs associated with spermatogenesis and immunity. We suggest when measuring sexual differences in immunity it is important to consider the effects of reproductive pressures, parasite types, and life history costs