Using a conceptual framework during learning attenuates the loss of expert-type knowledge structure

BACKGROUND: During evolution from novice to expert, knowledge structure develops into an abridged network organized around pathophysiological concepts. The objectives of this study were to examine the change in knowledge structure in medical students in one year and to investigate the association between the use of a conceptual framework (diagnostic scheme) and long-term knowledge structure. METHODS: Medical students' knowledge structure of metabolic alkalosis was studied after instruction and one year later using concept-sorting. Knowledge structure was labeled 'expert-type' if students shared ≥ 2 concepts with experts and 'novice-type' if they shared < 2 concepts. Conditional logistic regression was used to study the association between short-term knowledge structure, the use of a diagnostic scheme and long-term knowledge structure. RESULTS: Thirty-four medical students completed the concept-sorting task on both occasions. Twenty-four used a diagnostic scheme for metabolic alkalosis. Short-term knowledge structure was not a correlate of long-term knowledge structure, whereas use of a diagnostic scheme was associated with increased odds of expert-type long-term knowledge structure (odds ratio 12.6 [1.4, 116.0], p = 0.02). There was an interaction between short-term knowledge structure and the use of a diagnostic scheme. In the group who did not use a diagnostic scheme the number of students changing from expert-type to novice-type was greater than vice versa (p = 0.046). There was no significant change in the group that used the diagnostic scheme (p = 0.6). CONCLUSION: The use of a diagnostic scheme by students may attenuate the loss of expert-type knowledge structure

Reliability of KT1000 Knee Arthrometer Measures Obtained at Three Knee Joint Positions

Abstract: The reliability of KT1000 knee arthrometer measurements has been established at a flexion angle of 20° to 30°. However, no studies have assessed its reliability at multiple joint positions. This study was conducted in order to compare the displacement at three positions (20°, 45°, and 90°) and to determine the test-retest reliability at each position. Twenty subjects having no history of knee pathology participated in the study. A KT1000 knee arthrometer (MEDmetric Corporation, San Diego, CA) was positioned on the leg to measure anterior displacement of the proximal tibia at the three knee joint positions in random order. Post-hoc analysis indicated greater displacement at the 20° and 45° positions than at the 90° position. Intraclass correlation coefficients for the test-retest sessions were R=.92, .84 , and .90 for the 20°, 45°, and 90° positions, respectively. These findings suggest that the KT1000 is a reliable instrument for measurement of passive anterior displacement throughout the knee joint&apos;s range of motion. Injury to the anterior cruciate ligament may involve rupture of the entire ligament, or may be isolated to a particular portion of the ligament. As such, assessment of anterior displacement at multiple joint angles is recommended to most accurately evaluate the integrity of the anterior cruciate ligament. Article: The recent development of knee arthrometers has enabled objective measurement of knee joint displacement. The KT1000 arthrometer (MEDmetric Corporation, San Diego, CA), the Stryker knee laxity tester (Stryker, Kalamazoo, MI), and the Genucom knee analyzer (FARO Medical Tech. Inc., Montreal, Canada) are examples of instruments that have been designed to objectively measure laxity of the knee joint. These instruments appear to be correct 70 to 75% of the time in determining cruciate ligament integrity (1). The results of arthrometer measurements help to increase confidence in clinical diagnosis. Several investigators have examined the reliability of these instruments with the knee in a flexion angle of 20° to 30°. Highenboten et al. (8) found that the three previously-mentioned knee laxity testing devices provided reproducible quantitative measurements of knee laxity. Others have reported high correlation coefficients for the KT1000 with the knee in the standard 20° to 30° flexion angle (2,6). However, the reliability of measurement with this instrument at multiple joint positions has not been established

Can standardized patients replace physicians as OSCE examiners?

BACKGROUND: To reduce inter-rater variability in evaluations and the demand on physician time, standardized patients (SP) are being used as examiners in OSCEs. There is concern that SP have insufficient training to provide valid evaluation of student competence and/or provide feedback on clinical skills. It is also unknown if SP ratings predict student competence in other areas. The objectives of this study were: to examine student attitudes towards SP examiners; to compare SP and physician evaluations of competence; and to compare predictive validity of these scores, using performance on the multiple choice questions examination (MCQE) as the outcome variable. METHODS: This was a cross-sectional study of third-year medical students undergoing an OSCE during the Internal Medicine clerkship rotation. Fifty-two students rotated through 8 stations (6 physician, 2 SP examiners). Statistical tests used were Pearson's correlation coefficient, two-sample t-test, effect size calculation, and multiple linear regression. RESULTS: Most students reported that SP stations were less stressful, that SP were as good as physicians in giving feedback, and that SP were sufficiently trained to judge clinical skills. SP scored students higher than physicians (mean 90.4% +/- 8.9 vs. 82.2% +/- 3.7, d = 1.5, p < 0.001) and there was a weak correlation between the SP and physician scores (coefficient 0.4, p = 0.003). Physician scores were predictive of summative MCQE scores (regression coefficient = 0.88 [0.15, 1.61], P = 0.019) but there was no relationship between SP scores and summative MCQE scores (regression coefficient = -0.23, P = 0.133). CONCLUSION: These results suggest that SP examiners are acceptable to medical students, SP rate students higher than physicians and, unlike physician scores, SP scores are not related to other measures of competence

A prospective randomized trial of content expertise versus process expertise in small group teaching

Article deposited according to agreement with BMC, December 6, 2010.YesFunding provided by the Open Access Authors Fund

The GBT 350-MHz Drift Scan Pulsar Survey. III. Detection of a magnetic field in the eclipsing material of PSR J2256-1024

We present the first measurement of a non-zero magnetic field in the eclipsing material of a black widow pulsar. Black widows are millisecond pulsars which are ablating their companions; therefore they are often proposed as one potential source of isolated millisecond pulsars. PSR J2256-1024 is an eclipsing black widow discovered at radio wavelengths and later also observed in the X-ray and gamma parts of the spectrum. Here we present the radio timing solution for PSR J2256-1024, polarization profiles at 350, 820, and 1500~MHz and an investigation of changes in the polarization profile due to eclipsing material in the system. In the latter we find evidence of Faraday rotation in the linear polarization shortly after eclipse, measuring a rotation measure of 0.44(6) rad per meter squared and a corresponding line-of-sight magnetic field of 3.5(17) mG.Comment: 14 pages, 8 figure

BBF RFC 112: Synthetic Biology Open Language (SBOL) Version 2.1.0

BBF RFC 112 (the SBOL 2.1.0 standard) replaces BBF RFC 108 (the SBOL 2.0 standard), as well as the minor update SBOL 2.0.1.The Synthetic Biology Open Language (SBOL) has been developed as a standard to support the specification and exchange of biological design information

Multi-Messenger Gravitational Wave Searches with Pulsar Timing Arrays: Application to 3C66B Using the NANOGrav 11-year Data Set

When galaxies merge, the supermassive black holes in their centers may form binaries and, during the process of merger, emit low-frequency gravitational radiation in the process. In this paper we consider the galaxy 3C66B, which was used as the target of the first multi-messenger search for gravitational waves. Due to the observed periodicities present in the photometric and astrometric data of the source of the source, it has been theorized to contain a supermassive black hole binary. Its apparent 1.05-year orbital period would place the gravitational wave emission directly in the pulsar timing band. Since the first pulsar timing array study of 3C66B, revised models of the source have been published, and timing array sensitivities and techniques have improved dramatically. With these advances, we further constrain the chirp mass of the potential supermassive black hole binary in 3C66B to less than $(1.65\pm0.02) \times 10^9~{M_\odot}$ using data from the NANOGrav 11-year data set. This upper limit provides a factor of 1.6 improvement over previous limits, and a factor of 4.3 over the first search done. Nevertheless, the most recent orbital model for the source is still consistent with our limit from pulsar timing array data. In addition, we are able to quantify the improvement made by the inclusion of source properties gleaned from electromagnetic data to `blind' pulsar timing array searches. With these methods, it is apparent that it is not necessary to obtain exact a priori knowledge of the period of a binary to gain meaningful astrophysical inferences.Comment: 14 pages, 6 figures. Accepted by Ap

Involvement in teaching improves learning in medical students: a randomized cross-over study

<p>Abstract</p> <p>Background</p> <p>Peer-assisted learning has many purported benefits including preparing students as educators, improving communication skills and reducing faculty teaching burden. But comparatively little is known about the effects of teaching on learning outcomes of peer educators in medical education.</p> <p>Methods</p> <p>One hundred and thirty-five first year medical students were randomly allocated to 11 small groups for the Gastroenterology/Hematology Course at the University of Calgary. For each of 22 sessions, two students were randomly selected from each group to be peer educators. Students were surveyed to estimate time spent preparing as peer educator versus group member. Students completed an end-of-course 94 question multiple choice exam. A paired t-test was used to compare performance on clinical presentations for which students were peer educators to those for which they were not.</p> <p>Results</p> <p>Preparation time increased from a mean (SD) of 36 (33) minutes baseline to 99 (60) minutes when peer educators (Cohen's <it>d </it>= 1.3; p < 0.001). The mean score (SD) for clinical presentations in which students were peer educators was 80.7% (11.8) compared to77.6% (6.9) for those which they were not (<it>d </it>= 0.33; <it>p </it>< 0.01).</p> <p>Conclusion</p> <p>Our results suggest that involvement in teaching small group sessions improves medical students' knowledge acquisition and retention.</p

The NANOGrav 12.5-Year Data Set: Dispersion Measure Mis-Estimation with Varying Bandwidths

Noise characterization for pulsar-timing applications accounts for interstellar dispersion by assuming a known frequency-dependence of the delay it introduces in the times of arrival (TOAs). However, calculations of this delay suffer from mis-estimations due to other chromatic effects in the observations. The precision in modeling dispersion is dependent on the observed bandwidth. In this work, we calculate the offsets in infinite-frequency TOAs due to mis-estimations in the modeling of dispersion when using varying bandwidths at the Green Bank Telescope. We use a set of broadband observations of PSR J1643-1224, a pulsar with an excess of chromatic noise in its timing residuals. We artificially restricted these observations to a narrowband frequency range, then used both data sets to calculate residuals with a timing model that does not include short-scale dispersion variations. By fitting the resulting residuals to a dispersion model, and comparing the ensuing fitted parameters, we quantify the dispersion mis-estimations. Moreover, by calculating the autocovariance function of the parameters we obtained a characteristic timescale over which the dispersion mis-estimations are correlated. For PSR J1643-1224, which has one of the highest dispersion measures (DM) in the NANOGrav pulsar timing array, we find that the infinite-frequency TOAs suffer from a systematic offset of ~22 microseconds due to DM mis-estimations, with correlations over ~1 month. For lower-DM pulsars, the offset is ~7 microseconds. This error quantification can be used to provide more robust noise modeling in NANOGrav's data, thereby increasing sensitivity and improving parameter estimation in gravitational wave searches.Comment: 15 pages, 7 figure