Improving clerkship preparedness: a hospital medicine elective for pre-clerkship students.

BackgroundMedical students often struggle to apply their nascent clinical skills in clerkships. While transitional clerkships can orient students to new roles and logistics, students may benefit from developing clinical skills in inpatient environments earlier in their curriculum to improve readiness for clerkships.InterventionOur four- to six-session elective provides pre-clerkship students with individualized learning in the inpatient setting with the aim of improving clerkship preparedness. Students work one-on-one with faculty who facilitate individualized learning through mentoring, deliberate practice, and directed feedback. Second-year medical students are placed on an attending-only, traditionally 'non-teaching' service in the hospital medicine division of a Veterans Affairs (VA) hospital for half-day sessions. Most students self-select into the elective following a class-wide advertisement. The elective also accepts students who are referred for remediation of their clinical skills.OutcomeIn the elective's first two years, 25 students participated and 47 students were waitlisted. We compared participant and waitlisted (non-participant) students' self-efficacy in several clinical and professional domains during their first clerkship. Elective participants reported significantly higher clerkship preparedness compared to non-participants in the areas of physical exam, oral presentation, and formulation of assessments and plans.ConclusionsStudents found the one-on-one feedback and personalized attention from attending physicians to be a particularly useful aspect of the course. This frequently cited benefit points to students' perceived needs and the value they place on individualized feedback. Our innovation harnesses an untapped resource - the hospital medicine 'non-teaching' service - and serves as an attainable option for schools interested in enhancing early clinical skill-building for all students, including those recommended for remediation.AbbreviationsA&P: Assessment and plan; H&P: History and physical; ILP: Individual learning plan

Swift observations of the 2006 outburst of the recurrent nova RS Ophiuchi: II. 1D hydrodynamical models of wind driven shocks

Following the early Swift X-ray observations of the latest outburst of the recurrent nova RS Ophiuchi in February 2006 (Paper I), we present new 1D hydrodynamical models of the system which take into account all three phases of the remnant evolution. The models suggest a novel way of modelling the system by treating the outburst as a sudden increase then decrease in wind mass-loss rate and velocity. The differences between this wind model and previous Primakoff-type simulations are described. A more complex structure, even in 1D, is revealed through the presence of both forward and reverse shocks, with a separating contact discontinuity. The effects of radiative cooling are investigated and key outburst parameters such as mass-loss rate, ejecta velocity and mass are varied. The shock velocities as a function of time are compared to the ones derived in Paper I. We show how the manner in which the matter is ejected controls the evolution of the shock and that for a well-cooled remnant, the shock deceleration rate depends on the amount of energy that is radiated away.Comment: 9 pages, 5 figure

Twisted Fermi surface of a thin-film Weyl semimetal

The Fermi surface of a conventional two-dimensional electron gas is equivalent to a circle, up to smooth deformations that preserve the orientation of the equi-energy contour. Here we show that a Weyl semimetal confined to a thin film with an in-plane magnetization and broken spatial inversion symmetry can have a topologically distinct Fermi surface that is twisted into a \mbox{figure-8} $-$ opposite orientations are coupled at a crossing which is protected up to an exponentially small gap. The twisted spectral response to a perpendicular magnetic field $B$ is distinct from that of a deformed Fermi circle, because the two lobes of a \mbox{figure-8} cyclotron orbit give opposite contributions to the Aharonov-Bohm phase. The magnetic edge channels come in two counterpropagating types, a wide channel of width $\beta l_m^2\propto 1/B$ and a narrow channel of width $l_m\propto 1/\sqrt B$ (with $l_m=\sqrt{\hbar/eB}$ the magnetic length and $\beta$ the momentum separation of the Weyl points). Only one of the two is transmitted into a metallic contact, providing unique magnetotransport signatures.Comment: V4: 10 pages, 14 figures. Added figure and discussion about "uncrossing deformations" of oriented contours, plus minor corrections. Published in NJ

A periodically active pulsar giving insight into magnetospheric physics

PSR B1931+24 (J1933+2421) behaves as an ordinary isolated radio pulsar during active phases that are 5-10 days long. However, the radio emission switches off in less than 10 seconds and remains undetectable for the next 25-35 days, then it switches on again. This pattern repeats quasi-periodically. The origin of this behaviour is unclear. Even more remarkably, the pulsar rotation slows down 50% faster when it is on than when it is off. This indicates a massive increase in magnetospheric currents when the pulsar switches on, proving that pulsar wind plays a substantial role in pulsar spin-down. This allows us, for the first time, to estimate the currents in a pulsar magnetospheric during the occurrence of radio emission.Comment: 12 pages, 2 figure

Impact of Human Immunodeficiency Virus Infection on the Outcome of Treatment and Survival of Tuberculosis Patients in Mwanza, Tanzania.

Little is known about the outcome of tuberculosis (TB) treatment and subsequent survival of human immunodeficiency virus (HIV) infected patients treated under routine programme conditions in a developing country. We followed a cohort of HIV-positive and HIV-negative tuberculosis patients during therapy and assessed their vital and tuberculosis status 3 years after completion of treatment in Mwanza, Tanzania. Newly diagnosed and relapse tuberculosis cases consecutively registered over a 6-month period were enrolled into an epidemiological study of TB/HIV. Treatment outcome was based on information in tuberculosis treatment registers. Patients surviving treatment were assessed 3 years later by personal interview. Cause of death was determined by verbal autopsy. Of 561 patients enrolled into the study, 505 patients alive at completion of treatment were eligible for assessment at 3 years. Except for mortality, HIV infection was not statistically associated with differing treatment outcomes. At time of follow-up, the overall mortality was 19% and was associated with HIV infection (hazard ratio [hr] 3.7, 95% confidence interval [CI] 2.6-5.2) and age 35 years and over (hr 1.5, 95% CI 1.02-2.1), but not with type of tuberculosis, gender, or initial drug resistance. By life table analysis, probability of survival at 4 years was 35% for HIV-positive patients compared to 90% for HIV-negative patients. Although no relapse cases were diagnosed, verbal autopsy suggested equivalent low rates of relapse in both groups. These results demonstrate the effectiveness of the current approach to the treatment of tuberculosis patients regardless of HIV status. However, HIV-related mortality remains high both during and following completion of treatment, and further studies are needed to determine if this mortality might be reduced by simple interventions which are feasible in developing countries.\u

Staff satisfaction and retention and the role of the Nursing Unit Manager

Despite recent increases in nursing recruitment in Australia, participation in the workforce is still below the numbers predicted to meet future needs. This paper discusses factors impacting on nurses' job satisfaction, satisfaction with nursing and intention to leave in public sector hospitals in New South Wales (NSW), Australia. Staffing and patient data were collected on 80 medical and surgical units during 2004/5. This included a wide range of individual nurse data from a Nurse Survey; detailed and comprehensive staffing data including skill mix variables; patient characteristics; workload data; a profile of the ward's characteristics; and adverse event patient data. Nurses who were intending to remain in their job were more likely to be satisfied, be older, and have dependents. They were also likely to be experiencing good leadership and to have allied health support on the ward. Most nurses reported being satisfied with their profession, while a lower proportion reported satisfaction with their current position. Work environment factors such as nurses' autonomy, control over their practice and nursing leadership on the ward were statistically significant predictors of job satisfaction. This study will inform decision-making and policy for managers in both the public and private hospital sectors. This is the first large study which explored the work environment at the ward/unit level in public hospitals in NSW (Australia). It illustrates that there are no typical wards; each ward functions differently. The importance of nursing leadership at the ward level to job satisfaction, satisfaction with nursing and intention to leave, cannot be overstated. Crown Copyright © 2009

An Atlas of Computed Equivalent Widths of Quasar Broad Emission Lines

We present graphically the results of several thousand photoionization calculations of broad emission line clouds in quasars, spanning seven orders of magnitude in hydrogen ionizing flux and particle density. The equivalent widths of 42 quasar emission lines are presented as contours in the particle density - ionizing flux plane for a typical incident continuum shape, solar chemical abundances, and cloud column density of $N(H) = 10^{23} cm^{-2}$. Results are similarly given for a small subset of emission lines for two other column densities ($10^{22} cm^{-2}$ and $10^{24} cm^{-2}$), five other incident continuum shapes, and a gas metallicity of 5 \Zsun. These graphs should prove useful in the analysis of quasar emission line data and in the detailed modeling of quasar broad emission line regions. The digital results of these emission line grids and many more are available over the Internet.Comment: 16 pages, LaTeX (AASTeX aaspp4.sty); to appear in the 1997 ApJS: full contents of the 9 photoionization grids presented in this paper may be found at http://www.pa.uky.edu/~korista/grids/grids.htm

A Review of the Relationship of the ENC and DNC Hydrographic Vector Data Products

This document discusses the level of harmonization between the S-57 and DIGEST standards and the relationship between the ENC and DNC products. It is shown that the military and regulated commercial navigation have different needs, and that it is natural to have two different standards. However, in those areas where the needs overlap the standards should be equivalent. Commercial navigation requires "official" data whereas the military require a broad range of the "best available data". These needs are complementary. At the content level ENC data can be a pure subset of DNC data, however additional harmonization is required to achieve this