Self-perceived attitudes and skills of cultural competence: a comparison of family medicine and internal medicine residents

This study surveyed resident perceptions of competent cross-cultural doctor-patient communication as a step toward developing an integrative primary care cross-cultural curriculum. Respondents were 57 first-, second- and third-year residents in family medicine (FA) and internal medicine (IMA) who completed a questionnaire assessing cross-cultural attitudes and skills relevant to clinical practice. As a group, residents endorsed the relevance of culturally competent communication to patient care, perceived themselves to be fairly competent in the use of culturally competent communication technique, used such techniques frequently, and generally found them to be quite helpful. FM residents rated culturally competent communication as significantly more relevant, themselves as more competent, and culturally competent communication techniques as more helpful than did IM residents. Over half the residents in both specialties tended to identify as serious cross-cultural problems those that focused on perceived patient shortcomings

Metallicity Gradients in the Milky Way Disk as Observed by the SEGUE Survey

The observed radial and vertical metallicity distribution of old stars in the Milky Way disk provides a powerful constraint on the chemical enrichment and dynamical history of the disk. We present the radial metallicity gradient, \Delta[Fe/H]/\Delta R, as a function of height above the plane, |Z|, using 7010 main sequence turnoff stars observed by the Sloan Extension for Galactic Understanding and Exploration (SEGUE) survey. The sample consists of mostly old thin and thick disk stars, with a minimal contribution from the stellar halo, in the region 6 < R < 16 kpc, 0.15 < |Z| < 1.5 kpc. The data reveal that the radial metallicity gradient becomes flat at heights |Z| > 1 kpc. The median metallicity at large |Z| is consistent with the metallicities seen in outer disk open clusters, which exhibit a flat radial gradient at [Fe/H] ~ -0.5. We note that the outer disk clusters are also located at large |Z|; because the flat gradient extends to small R for our sample, there is some ambiguity in whether the observed trends for clusters are due to a change in R or |Z|. We therefore stress the importance of considering both the radial and vertical directions when measuring spatial abundance trends in the disk. The flattening of the gradient at high |Z| also has implications on thick disk formation scenarios, which predict different metallicity patterns in the thick disk. A flat gradient, such as we observe, is predicted by a turbulent disk at high redshift, but may also be consistent with radial migration, as long as mixing is strong. We test our analysis methods using a mock catalog based on the model of Sch\"onrich & Binney, and we estimate our distance errors to be ~25%. We also show that we can properly correct for selection biases by assigning weights to our targets.Comment: Submitted to ApJ; 22 pages, 14 figures in emulateapj format; Full resolution version available at http://www.ucolick.org/~jyc/gradient/cheng_apj_fullres.pd

Curriculum implementation exploratory studies: Final report

Throughout the history of schooling in New Zealand the national curriculum has been revised at fairly regular intervals. Consequently, schools are periodically faced with having to accommodate to new curriculum. In between major changes other specifically-focused changes may arise; for example, the increased recent emphasis upon numeracy and literacy

Creation and Curation of the Society of Imaging Informatics in Medicine Hackathon Dataset

In order to support innovation, the Society of Imaging Informatics in Medicine (SIIM) elected to create a collaborative computing experience called a "hackathon." The SIIM Hackathon has always consisted of two components, the event itself and the infrastructure and resources provided to the participants. In 2014, SIIM provided a collection of servers to participants during the annual meeting. After initial server setup, it was clear that clinical and imaging "test" data were also needed in order to create useful applications. We outline the goals, thought process, and execution behind the creation and maintenance of the clinical and imaging data used to create DICOM and FHIR Hackathon resources

Examining the effect of peer helping in a coping skills intervention: a randomized controlled trial for advanced gastrointestinal cancer patients and their family caregivers

PURPOSE: At the end of life, spiritual well-being is a central aspect of quality of life for many patients and their family caregivers. A prevalent spiritual value in advanced cancer patients is the need to actively give. To address this need, the current randomized trial examined whether adding a peer helping component to a coping skills intervention leads to improved meaning in life and peace for advanced gastrointestinal cancer patients and their caregivers. Feasibility and acceptability outcomes were also assessed. METHODS: Advanced gastrointestinal cancer patients and caregivers (n = 50 dyads) were randomly assigned to a 5-session, telephone-based coping skills intervention or a peer helping + coping skills intervention. One or both dyad members had moderate-severe distress. Peer helping involved contributing to handouts on coping skills for other families coping with cancer. Patients and caregivers completed measures of meaning in life/peace, fatigue, psychological symptoms, coping self-efficacy, and emotional support. Patient pain and caregiver burden were also assessed. RESULTS: Small effects in favor of the coping skills group were found regarding meaning in life/peace at 1 and 5 weeks post-intervention. Other outcomes did not vary as a function of group assignment, with both groups showing small decreases in patient and caregiver fatigue and caregiver distress and burden. High recruitment and retention rates supported feasibility, and high participant satisfaction ratings supported acceptability. CONCLUSIONS: Although a telephone-based intervention is feasible and acceptable for this population, peer helping in the context of a coping skills intervention does not enhance spiritual well-being relative to coping skills alone

ADAPTIVE ROWING – ROWING OR SCULLING FOR ROWERS WITH A DISABILITY

Prilagođeno veslanje je bilo najmlađi sport na Paraolimpijskim igrama (POI) u Pekingu, Narodna Republika Kina 2008. godine. Iako se na međunarodnoj razini počelo razvijati tek prije desetak godina danas je prilagođeno veslanje rasprostranjeno po cijelome svijetu i dobro je razvijeno što je razvidno iz činjenice da je 12 veslačkih medalja na navedenim POI bilo „podijeljeno“ između 9 država s pet kontinenata. Prilagođeno veslanje je veslanje za osobe s invalidnošću koje ispunjavaju kriterije određene u pravilima za klasificiranje prilagođenog veslanja. Prilagođeno znači da je oprema „prilagođena“ sportašima, a ne da im je „prilagođen“ sam sport. Prilagoðenim se veslanjem bave i žene i muškarci, a trenutno postoje četiri discipline (ženski samac – AW1, muški samac – AM1, dvojac na pariæe – TAMix2x i četverac s kormilarom – LTAMix4+) u kojima se natječu veslači ovisno o stupnju tjelesnog oštećenja. Natjecanja se u svim disciplinama odvijaju na stazi duljine 1000 m. Da bi se veslači s različitim stupnjevima tjelesnih oštećenja mogli natjecati na meðunarodnim regatama pod okriljem FISA-e te na POI moraju biti razvrstani ovisno o stupnju invalidnosti od strane FISA-inih međunarodnih klasifikatora tj. jednog medicinskog i jednog tehničkog klasifikatora. Svrha klasifikacije je osiguravanje što je moguće poštenijeg natjecanja sportaša s različitim stupnjevima tjelesnih oštećenja. Prilagođeno veslanje donosi cijeli niz kako fizičkih tako i psihičkih dobrobiti svojim natjecateljima. Kao i kod svake druge sportske aktivnosti, postoje i određeni rizici po zdravlje i život tijekom bavljenja prilagođenim veslanjem, no oni se znanjem i pravilnom organizacijom mogu svesti na minimum.Adaptive Rowing was the youngest sport at the Paralympic Games in Beijing, Peoples Republic of China 2008. Although its international development started just over 10 years ago, Adaptive Rowing is widespread and well developed. To confirm this, 12 rowing Paralympics medals at the mentioned Paralympic Games were “divided” among nine countries from five continents. Adaptive rowing is rowing or sculling for rowers with a disability who meet the criteria set out in the adaptive rowing classification guidelines. Adaptive implies that the equipment is “adapted” to the user to practice the sport, rather than the sport being “adapted” to the user. Adaptive rowing is open to male and female rowers, and is currently divided into four boat classes: LTAMx4+, TA2x, AW1x and AM1x. The LTAMx4+ and TA2x classes are mixed gender boats. All boat classes compete over a distance of 1,000 meters. In order to compete in a FISA international regatta, including the Paralympic Games, rowers must be classified by a panel of two FISA International Classifiers - one medical and one technical. The objective of this classification is to provide competition that is as fair as possible by grouping athletes according to their ability to perform the particular sport of rowing. Adaptive Rowing brings a variety of benefits including physical and psychological improvements to its competitors. As with any sport, there are certain risks for health and life during Adaptive Rowing, but they can be diminished to a minimum by knowledge and appropriate organization

Epstein-Barr Virus Associated Modulation of Wnt Pathway Is Not Dependent on Latent Membrane Protein-1

Previous studies have indicated that Epstein-Barr virus (EBV) can modulate the Wnt pathway in virus-infected cells and this effect is mediated by EBV-encoded oncogene latent membrane protein 1 (LMP1). Here we have reassessed the role of LMP1 in regulating the expression of various mediators of the canonical Wnt cascade. Contradicting the previous finding, we found that the levels of E-cadherin, β-catenin, Glycogen Synthase Kinase 3ß (GSK3β), axin and α-catenin were not affected by the expression of LMP1 sequences from normal B cells or nasopharyngeal carcinoma. Moreover, we also show that LMP1 expression had no detectable effect on the E-cadherin and β-catenin interaction and did not induce transcriptional activation of β-catenin. Taken together these studies demonstrate that EBV-mediated activation of Wnt pathway is not dependent on the expression of LMP1

Ventricular Tachyarrhythmias after Cardiac Arrest in Public versus at Home

Background The incidence of ventricular fibrillation or pulseless ventricular tachycardia as the first recorded rhythm after out-of-hospital cardiac arrest has unexpectedly declined. The success of bystander-deployed automated external defibrillators (AEDs) in public settings suggests that this may be the more common initial rhythm when outof-hospital cardiac arrest occurs in public. We conducted a study to determine whether the location of the arrest, the type of arrhythmia, and the probability of survival are associated. Methods Between 2005 and 2007, we conducted a prospective cohort study of out-of-hospital cardiac arrest in adults in 10 North American communities. We assessed the frequencies of ventricular fibrillation or pulseless ventricular tachycardia and of survival to hospital discharge for arrests at home as compared with arrests in public. Results Of 12,930 evaluated out-of-hospital cardiac arrests, 2042 occurred in public and 9564 at home. For cardiac arrests at home, the incidence of ventricular fibrillation or pulseless ventricular tachycardia was 25% when the arrest was witnessed by emergency-medical-services (EMS) personnel, 35% when it was witnessed by a bystander, and 36% when a bystander applied an AED. For cardiac arrests in public, the corresponding rates were 38%, 60%, and 79%. The adjusted odds ratio for initial ventricular fibrillation or pulseless ventricular tachycardia in public versus at home was 2.28 (95% confidence interval [CI], 1.96 to 2.66; P\u3c0.001) for bystanderwitnessed arrests and 4.48 (95% CI, 2.23 to 8.97; P\u3c0.001) for arrests in which bystanders applied AEDs. The rate of survival to hospital discharge was 34% for arrests in public settings with AEDs applied by bystanders versus 12% for arrests at home (adjusted odds ratio, 2.49; 95% CI, 1.03 to 5.99; P=0.04). Conclusions Regardless of whether out-of-hospital cardiac arrests are witnessed by EMS personnel or bystanders and whether AEDs are applied by bystanders, the proportion of arrests with initial ventricular fibrillation or pulseless ventricular tachycardia is much greater in public settings than at home. The incremental value of resuscitation strategies, such as the ready availability of an AED, may be related to the place where the arrest occurs. (Funded by the National Heart, Lung, and Blood Institute and others.