Proteome and Physiological Characterization of Halotolerant Nodule Endophytes: The Case of Rahnella aquatilis and Serratia plymuthica

Bacterial endophytes were isolated from nodules of pea and fava bean. The strains were identified and characterized for plant beneficial activities (phosphate solubilization, synthesis of indole acetic acid and siderophores) and salt tolerance. Based on these data, four strains of Rahnella aquatilis and three strains of Serratia plymuthica were selected. To shed light on the mechanisms underlying salt tolerance, the proteome of the two most performant strains (Ra4 and Sp2) grown in the presence or not of salt was characterized. The number of proteins expressed by the endophytes was higher in the presence of salt. The modulated proteome consisted of 302 (100 up-regulated, 202 down-regulated) and 323 (206 up-regulated, 117 down-regulated) proteins in Ra4 and Sp2, respectively. Overall, proteins involved in abiotic stress responses were up-regulated, while those involved in metabolism and flagellum structure were down-regulated. The main up-regulated proteins in Sp2 were thiol: disulfide interchange protein DsbA, required for the sulfur binding formation in periplasmic proteins, while in Ra4 corresponded to the soluble fraction of ABC transporters, having a role in compatible solute uptake. Our results demonstrated a conserved response to salt stress in the two taxonomically related species

Development of a longitudinal integrated clerkship at an academic medical center

In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center

Faculty verbal evaluations reveal strategies used to promote medical student performance

Background: Preceptors rarely follow medical students’ developing clinical performance over time and across disciplines. This study analyzes preceptors’ descriptions of longitudinal integrated clerkship (LIC) students’ clinical development and their identification of strategies to guide students’ progress. Methods: We used a common evaluation framework, reporter-interpreter-manager-educator, to guide multidisciplinary LIC preceptors’ discussions of students’ progress. We conducted thematic analysis of transcripts from preceptors’ (seven longitudinal ambulatory preceptors per student) quarterly group discussions of 15 students’ performance over one year. Results: All students’ clinical development progressed, although most experienced obstacles. Lack of structure in the history and physical exam commonly obstructed progression. Preceptors used templates for data gathering, and modeling or experiences in the inpatient setting to provide time and solidify structure. To advance students’ knowledge acquisition, many preceptors identified focused learning topics with their students; to promote application of knowledge, preceptors used reasoning strategies to teach the steps involved in synthesizing clinical data. Preceptors shared accountability for helping students advance as the LIC allowed them to follow students’ response to teaching strategies. Discussion: These results depict preceptors’ perceptions of LIC students’ developmental continuum and illustrate how multidisciplinary preceptors can use a common evaluation framework to identify strategies to improve performance and follow students’ performance longitudinally

Electronic Medical Records: Provotype visualisation maximises clinical usability

The Electronic Medical Record (EMR) is the essential tool of the clinical consultation, effectively replacing the paper medical record. Since its gradual adoption in the early 2000s there has been a failure to achieve even moderate levels of EMR usability in clinical settings, resulting in a negative impact on clinical care, time efficiency and patient safety. This research explores how deeper collaboration with clinical users through participatory design, drawing on the disciplines of visual design, user experience (UX) design and visual analytics, might offer a more effective approach to this important problem. The lead researcher for this project is both a practising doctor and design researcher. Usability of two commercial EMR interfaces in the field of sexual health is explored through a mixed method survey, with responses used to inform the design of an interface provotype. This in turn is evaluated through repeat survey and ‘test-drive’ talk-aloud workshops. Results from the survey on two commercial EMR interfaces (n=49) revealed deep dissatisfaction particularly around issues of navigation, flow of consultation, frustration, safety, time-dependent and time-independent data, data complexity and data salience. Comparative provotype evaluation (n=63) showed that clinically-relevant visualisation offers marked gains in clinical usability and performance. This research argues for a re-imagining of the way we look at medical data during the clinical consultation so that the affordances and benefits of the digital format can be exploited more fully. It highlights the value of combining participatory design with visualisation to embed explicit, experiential and even tacit clinical knowledge into the EMR interface

A Poetics of Designing

The chapter provides an overview on what it means to be in a world that is uncertain, e.g., how under conditions of limited understanding any activity is an activity that designs and constructs, and how designing objects, spaces, and situations relates to the (designed) meta-world of second-order cybernetics. Designers require a framework that is open, but one that supplies ethical guidance when ‘constructing’ something new. Relating second-order design thinking to insights in philosophy and aesthetics, the chapter argues that second-order cybernetics provides a response to this ethical challenge and essentially it entails a poetics of designing. //// 'A Poetics of Designing' is part of the first book-length collection of texts in Design Cybernetics. It introduces the subject from the point of view of aesthetics. Importantly, the chapter argues that second-order cybernetics circumvents the necessity for a muse inspired artist or genius as a mediator between higher spirits and life, in favour of artists and designers who have true agency. //// Cybernetics is often associated with AI, which is, however, only one of the branches that developed on the basis of the interdisciplinary research begun in the 1940s and entitled cybernetics. I hope the chapter contributes to a better understanding of the second-order cybernetics that has been conceived in close relationship with art and design from the late 60s onwards