Failure of an Educational Intervention to Improve Consultation and Implications for Healthcare Consultation.

INTRODUCTION: Consultation of another physician for his or her specialized expertise regarding a patient's care is a common occurrence in most physicians' daily practice, especially in the emergency department (ED). Therefore, the ability to communicate effectively with another physician during a patient consultation is an essential skill. However, there has been limited research on a standardized method for a physician to physician consultation with little guidance on teaching consultations to physicians in training. The objective of our study was to measure the effect of a structured consultation intervention on both content standardization and quality of medical student consultations. METHODS: Senior medical students were assessed on a required emergency medicine rotation with a physician phone consultation during a standardized, simulated chest pain case. The intervention groups received a standard consult checklist as part of their orientation to the rotation, followed by a video recording of a good consult call and a bad consult call with commentary from an emergency physician. The intervention was given to students every other month, alternating with a control group who received no additional education. Recordings were reviewed by three second-year internal medicine residents pursuing a fellowship in cardiology. Each recording was evaluated by two of the three reviewers and scored using a standardized checklist. RESULTS: Providing a standardized consultation intervention did not improve students' ability to communicate with consultants. In addition, there was variability between evaluators in regards to how they received the same information and how they perceived the quality of the same recorded consultation calls. Evaluator inter-rater reliability (IRR) was poor on the questions of 1) would you have any other questions of the student calling the consult and 2) did the student calling the consult provide an accurate account of information and case detail. The IRR was also poor on objective data such as whether the student stated their name. CONCLUSIONS: A brief intervention may not be enough to change complex behavior such as a physician to physician consultant communication. Importantly, despite consultants listening to the same audio recordings, the information was processed differently. Future investigations should focus on both those delivering as well as those receiving a consultation

Teaching advocacy communication to pediatric residents: the efficacy of applied improvisational theater (AIT) as an instructional tool

In today’s communication landscape, the public often turn to the Internet and social media instead of their physician for health information. To remain relevant and respected amidst the wealth of health information available online, physicians need to offer something the Internet cannot fully emulate: empathetic imagination and an ability to instantaneously tailor messages to reach and teach worried and often confused audiences effectively. We developed an instructional communication module for pediatric residents that used applied improvisational theater to help residents develop complex and dynamic communication skills. The module included opportunities to develop empathy, practice audience analysis, distill messages to key points, and apply these skills in media and community contexts. Attendees completed surveys regarding their perceptions of curricular structure, efficacy, and utility. Preliminary results indicate gains in communication confidence and skills. This type of instructional communication and training module encourages healthcare practitioners to position themselves as trusted experts and partners in helping clients make meaning of health information, thus empowering a new generation of pediatricians to bridge communication gaps created by new technologies and increased access to multiple information sources

Stepping Stones: A Leadership Development Program to Inspire and Promote Reflection Among Women Faculty and Staff

Women frequently benefit from focused faculty development opportunities not because they need to be “fixed,” but rather it is a means to demonstrate that success, even in chilly environments, is possible. The Stepping Stones program uses a unique design to provide participants with inspiration, time for reflection, and strategies for how to navigate one's career, through hearing about the journeys of successful women. In this article, we describe the program and evaluation results. Post‐event and longitudinal follow‐up surveys indicate that the program and its unique narrative format help to debunk the superwoman myth and leave participants with a sense of optimism about their future careers

Poly(Limonene Thioether) Scaffold for Tissue Engineering

A photocurable thiol-ene network polymer, poly(limonene thioether) (PLT32o), is synthesized, characterized, fabricated into tissue engineering scaffolds, and demonstrated in vitro and in vivo. Micromolded PLT32o grids exhibit compliant, elastomeric mechanical behavior similar to grids made of poly(glycerol sebacate) (PGS), an established biomaterial. Multilayered PL32o scaffolds with regular, geometrically defined pore architectures support heart cell seeding and culture in a manner similar to multilayered PGS scaffolds. Subcutaneous implantation of multilayered PLT32o scaffolds with cultured heart cells provides long-term 3D structural support and retains the exogenous cells, whereas PGS scaffolds lose both their structural integrity and the exogenous cells over 31 d in vivo. PLT32o membrane implants retain their dry mass, whereas PGS implants lose 70 percent of their dry mass by day 31. Macrophages are initially recruited to PLT32o and PGS membrane implants but are no longer present by day 31. Facile synthesis and processing in combination with the capability to support heart cells in vitro and in vivo suggest that PLT32o can offer advantages for tissue engineering applications where prolonged in vivo maintenance of 3D structural integrity and elastomeric mechanical behavior are required.United States. National Institutes of Health (R01-HL107503

Time Delay and Accretion Disk Size Measurements in the Lensed Quasar SBS 0909+532 from Multiwavelength Microlensing Analysis

We present three complete seasons and two half-seasons of Sloan Digital Sky Survey (SDSS) r-band photometry of the gravitationally lensed quasar SBS 0909+532 from the U.S. Naval Observatory, as well as two seasons each of SDSS g-band and r-band monitoring from the Liverpool Robotic Telescope. Using Monte Carlo simulations to simultaneously measure the system’s time delay and model the r-band microlensing variability, we confirm and significantly refine the precision of the system’s time delay to ΔtAB = 50+2 −4 days, where the stated uncertainties represent the bounds of the formal 1σ confidence interval. There may be a conflict between the time delay measurement and a lens consisting of a single galaxy. While models based on the Hubble Space Telescope astrometry and a relatively compact stellar distribution can reproduce the observed delay, the models have somewhat less dark matter than we would typically expect. We also carry out a joint analysis of the microlensing variability in the r and g bands to constrain the size of the quasar’s continuum source at these wavelengths, obtaining log{(rs,r/cm)[cos i/0.5]1/2} = 15.3 ± 0.3 and log{(rs,g/cm)[cos i/0.5]1/2} = 14.8 ± 0.9, respectively. Our current results do not formally constrain the temperature profile of the accretion disk but are consistent with the expectations of standard thin disk theory

Exploring Gender Bias in Nursing Evaluations of Emergency Medicine Residents

Objectives Nursing evaluations are an important component of residents’ professional development as nurses are present for interactions with patients and nonphysician providers. Despite this, there has been few prior studies on the benefits, harms, or effectiveness of using nursing evaluations to help guide emergency medicine residents’ development. We hypothesized that gender bias exists in nursing evaluations and that female residents, compared to their male counterparts, would receive more negative feedback on the perception of their interpersonal communication skills. Methods Data were drawn from nursing evaluations of residents between March 2013 and April 2016. All comments were coded if they contained words falling into four main categories: standout, ability, grindstone, and interpersonal. This methodology and the list of words that guided coding were based on the work of prior scholars. Names and gendered pronouns were obscured and each comment was manually reviewed and coded for valence (positive, neutral, negative) and strength (certain or tentative) by at least two members of the research team. Following the qualitative coding, quantitative analysis was performed to test for differences. To evaluate whether any measurable differences in ability between male and female residents existed, we compiled and compared American Board of Emergency Medicine in‐training examination scores and relevant milestone evaluations between female and male residents from the same period in which the residents were evaluated by nursing staff. Results Of 1,112 nursing evaluations, 30% contained comments. Chi‐square tests on the distribution of valence (positive, neutral, or negative) indicated statistically significant differences in ability and grindstone categories based on the gender of the resident. A total of 51% of ability comments about female residents were negative compared to 20% of those about male residents (χ2 = 11.83, p < 0.01). A total of 57% of grindstone comments about female residents were negative as opposed 24% of those about male residents (χ2 = 6.03, p < 0.01). Conclusions Our findings demonstrate that, despite the lack of difference in ability or competence as measured by in‐service examination scores and milestone evaluations, nurses evaluate female residents lower in their abilities and work ethic compared to male residents

Safety and efficacy of alternative alglucosidase alfa regimens in Pompe disease

AbstractEmerging phenotypes in long-term survivors with Pompe disease on standard enzyme replacement therapy (ERT) (alglucosidase alfa 20 mg/kg/2 weeks) can include patients with worsening motor function. Whether higher doses of ERT improve skeletal function in these patients has not been systematically studied. This exploratory, randomized, open-label, 52-week study examined the safety and efficacy of 2 ERT regimens of alglucosidase alfa (20 mg/kg/week or 40 mg/kg/2 weeks) in 13 patients with Pompe disease and clinical decline or a lack of improvement on standard ERT: late-onset (n = 4), infantile-onset (n = 9). Cross-reactive immunologic material assay-negative patients were excluded. Eleven of 13 patients completed the study. Trends for improvement were seen in total gross motor function, but not mobility; however, 6 (late-onset, 2; infantile-onset, 4) of 11 patients (55%) who met the entry criteria of motor decline (late-onset, 4; infantile-onset, 7) showed improvement in motor and/or mobility skills. No between-regimen differences in efficacy emerged. Two case studies highlight the benefits of increased ERT dose in patients with Pompe disease experiencing clinical decline. Both alternative regimens were generally well tolerated. This study was limited by the small sample size, which is not uncommon for small clinical studies of rare diseases. Additionally, the study did not include direct assessment of muscle pathology, which may have identified potential causes of decreased response to ERT. Results were inconclusive but suggest that increased ERT dose may be beneficial in some patients with Pompe disease experiencing motor decline. Controlled studies are needed to clarify the benefits and risks of this strategy

Metal oxide–zeolite composites in transformation of methanol to hydrocarbons : do iron oxide and nickel oxide matter?

The methanol-to-hydrocarbon (MTH) reaction has received considerable attention as utilizing renewable sources of both value-added chemicals and fuels becomes a number one priority for society. Here, for the first time we report the development of hierarchical zeolites (ZSM-5) containing both iron oxide and nickel oxide nanoparticles. By modifying the iron oxide (magnetite, Fe3O4) amounts, we are able to control the catalyst activity and the product distribution in the MTH process. At the medium Fe3O4 loading, the major fraction is composed of C9–C11 hydrocarbons (gasoline fraction). At the higher Fe3O4 loading, C1–C4 hydrocarbons prevail in the reaction mixture, while at the lowest magnetite loading the major component is the C5–C8 hydrocarbons. Addition of Ni species to Fe3O4–ZSM-5 leads to the formation of mixed Ni oxides (NiO/Ni2O3) positioned either on top of or next to Fe3O4 nanoparticles. This modification allowed us to significantly improve the catalyst stability due to diminishing coke formation and disordering of the coke formed. The incorporation of Ni oxide species also leads to a higher catalyst activity (up to 9.3 g(methanol)/(g(ZSM-5) × h)) and an improved selectivity (11.3% of the C5–C8 hydrocarbons and 23.6% of the C9–C11 hydrocarbons), making these zeolites highly promising for industrial applications

Concert recording 2016-02-04

[Track 01]. Der Schmetterling / Franz Schubert -- [Track 02]. Moonshine lullaby from Annie get your gun / Irving Berlin -- [Track 03]. Voi, che sapete from Le Nozze di Figaro / Wolfgang Amadeus Mozart -- [Track 04]. Barcarolle from Les contes d\u27Hoffman / Jacques Offenbach -- [Track 05]. A maiden fair to see from H.M.S. Pinafore / Gilbert and Sullivan -- [Track 06]. Im wunderschönen Monat Mai from Dichterliebe / Robert Schumann -- [Track 07]. L\u27heure exquise / Reynaldo Hahn -- [Track 08]. And this is my beloved from Kismet / Wright ; Forest -- [Track 09]. Wenn mein Schatz Hochzeit macht from Lieder eines fahrenden Gesellen / Gustav Mahler -- [Track 10]. Va! Laisse couler mes larmes from Werther / Jules Massenet -- [Track 11]. Give me Jesus / traditional ; arranged by Moses Hogan -- [Track 12]. Il lacerato spirito from Simon Boccanegra / Giuseppe Verdi -- [Track 13]. Giunse alfin il momento...Deh viene, non tardar from Le nozze di Figaro / Wolfgang Amadeus Mozart -- [Track 14]. St. Ita\u27s vision from Hermit songs / Samuel Barber -- [Track 15]. Adele\u27s audition aria from Die Fledermaus / Johann Strauss -- [Track 16]. A part of that from The last five years / Jason Robert Brown -- [Track 17]. Two for the road / Henry Mancini -- [Track 18]. Nel cor piu non mi sento / Giovanni Paisiello -- [Track 19]. Love\u27s minstrels from The house of life / Ralph Vaughan-Williams -- [Track 20]. Der stürmische Morgen / Franz Schubert -- [Track 21]. Die Lotosblume / Robert Schumann -- [Track 22]. Nothing from A chorus line / Hammlisch ; Kleban -- [Track 23]. Spiel auf deiner Geige / Robert Stolz