Parent assessment of medical student skills in ambulatory pediatrics

Background: Partnership with parents is a vital part of pediatric medical education, yet few studies have examined parent attitudes towards learners in pediatric settings. Methods: Questionnaires were used to determine parent and student assessment of professional and clinical skills (primary outcome) and parent attitudes towards 3rd year medical students (secondary outcome) at the University of Alberta. Chi Square, Kendall’s Tau and Kappa coefficients were calculated to compare parent and student responses in 8 areas: communication, respect, knowledge, listening, history taking, physical examination, supervision, and overall satisfaction. Results: Overall satisfaction with medical student involvement by parents was high: 56.7% of all parents ranked the encounter as ‘excellent’. Areas of lesser satisfaction included physician supervision of students. Compared to the parent assessment, students tended to underrate many of their skills, including communication, history taking and physical exam. There was no relationship between parent demographics and their attitude to rating any of the students’ skills. Conclusions: Parents were satisfied with medical student involvement in the care of their children. Areas identified for improvement included increased supervision of students in both history taking and physical examination. This is one of the largest studies examining parent attitudes towards pediatric students. The results may enhance undergraduate curriculum development and teaching in pediatric ambulatory clinics and strengthen the ongoing partnership between the community and teaching clinics

Flexibla hyresavtal

Enligt Newsecs rapport från 2016 söker företag idag kontor som har effektiv kontorsyta med stor flexibilitet vad det gäller både area och hyresavtal. Deras analys är att sådana kontor kommer fortsätta att efterfrågas. Vad som menas med flexibla hyresavtal är inget som är självklart i branschen men i detta examensarbete innebär sådana hyresavtal kortare hyrestider och mindre ytor för varje aktör som hyr i kontoret. Detta ger ett större flöde av hyresgäster än vad det traditionellt sker i ett kontor. Syftet med examensarbetet är att undersöka hur investerares syn på flexibla hyresavtal för kontor är avseende hyra, hyrestid, yta och hyresgästanpassning, deras syn på kluster och hur lagstiftning styr användandet av flexiblare avtal. Genom en teoretisk studie av relevanta ekonomiska teorier, granskning av gällande lagstiftning och dagens trender studeras vad användandet av flexibla hyresavtal kan innebära. Kvalitativa intervjuer genomfördes för att förstår investerares inställning till flexibla hyresavtal och det är utefter dem slutsatserna framförallt har dragits. Slutsatsen är att det ultimata kontorshuset har en blandning av hyresavtal avseende parametrarna tid och yta då detta är ett sätt att sprida risken för investeraren. Hyran per kvadratmeter är högre ju färre kvadratmeter hyresgästen hyr men exakt hur mycket högre är en förhandlingsfråga som beror på flera parametrar. Den risk det är för investeraren med ett hyresavtal med kortare hyrestid kan få ett teoretiskt pris. Om hyresgästen betalar detta ”riskpris” anses risken vara hanterad. Investerare är dock ännu inte intresserade av ett kontor med endast flexibla hyresavtal. Även om efterfrågan verkar finnas är investerarna inte ännu intresserade av endast flexibla hyresavtal. Kluster är inget investerare konkret värdesätter utan det viktigaste är att kontoret har rätt läge med bra kommunikationsmöjligheter och tillgång till service. Lagstiftningens tvingande bestämmelser begränsar önskan om att skriva flexibla hyresavtal och på grund av det minskar investerares vilja att upprätta flexibla hyresavtal.According to Newsec's report from 2016 companies are looking for offices that have efficient office space with great flexibility in terms of both area and lease. Their analysis is that such offices will continue to be demanded. What is meant by flexible real estate leases is nothing that is obvious in the industry but in this paper such leases mean less lease times and less space for each participant who rent an office. This gives a greater flow of tenants than in a traditionally office. The purpose of the thesis is to investigate how investors attitude against flexible leases, rental time, area and tenancy adjustment, their views on clusters, and how legislation governs the use of flexible real estate leases. Through a theoretical study of relevant economic theories, a review of current legislation and current trends, what the use of flexible real estate leases can mean is being studied. Interviews were conducted to understand investors' attitude to flexible real estate leases and it is especially along those conclusions have been made. The conclusion is that the ultimate office house has a mix of real estate leases regarding the time and space parameters as this is a way of spreading the risk to the investor. The rent per square meter is higher then fewer square meters tenant rent but exactly how much higher is a negotiation question that depends on several parameters. The risk it is for the investor with a real estate leases with a shorter rental period can get a theoretical price. If the renter pays this "risk price" the risk is considered to be handled. However, investors are not yet interested in an office with only flexible real estate leases. Although demand seems to be, investors are not yet interested in only flexible real estate leases. Investors are not interested in cluster. The most important thing is that the office is in the right location with good communication opportunities and access to service. The law restrict the desire to write flexible real estate leases and, as a result, reduce investors' willingness to invest with flexible real estate lease

<特集>「生徒は何を読んでいるか、読書は何を育てるか」 自立した読書人となるように

Recent size-structured cannibalistic models point to the importance of the energy gain by cannibals and also show that this gain may result in the emergence of giant individuals. We use a combination of a 10-year field study of a perch (Perca fluviatilis) population and quantitative within-season modeling of individual and population-level dynamics to investigate which mechanisms are most likely to drive the dynamics of the studied perch population. We focused on three main aspects to explain observed discrepancies between earlier model predictions and data: (1) introduction of more than one shared resource between cannibals and victims, (2) whether or not several victim age cohorts are necessary to allow giant growth, and (3) the intensity of inter-cohort competition between young-of-the-year (YOY) perch and 1-yr-old perch. At the start of the study period, the perch population was dominated by “stunted” perch individuals, and recruitment of perch to an age of 1-yr-old was negligible. Following a major death in adult perch, strong recruitments of perch to 1-yr-old were thereafter observed for a number of years. As 1-yr-olds these successful recruiters subsequently starved to death due to competition with the new YOY. The few surviving adult perch accelerated substantially in growth and became “giants.” At the end of the study period, the perch population moved back to the situation with stunted individuals. There was a high agreement between observed diets of cannibalistic perch and those predicted by the model for both the stunted and the giant phases. Analyses of growth rates showed that cannibalistic perch could become giants on a diet of YOY perch only, but that a supplement with the second shared resource (macroinvertebrates) was needed to reach the observed sizes. Modeling of growth and diet in the giant phase showed an exploitative competitive effect of YOY perch on 1-yr-old perch, but a restriction in habitat use of 1-yr-old perch had to be assumed to yield the observed growth rate and diet. The resource dynamics of zooplankton and macroinvertebrates were both accurately predicted by the model. Also, YOY perch mortality was accurately predicted and, furthermore, suggested that one of the trawling methods used may underestimate the number of YOY perch when they increase in size. We conclude that the presence of a second shared resource and the restricted habitat use and absence of cannibalistic consumption by 1-yr-old perch individuals are two important mechanisms to explain the discrepancy between model predictions and data. Our results also point to the fact that that the dynamics observed may be explained by complex dynamics not involving the presence of a giant and dwarf cycle

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

The PREDICTS database: a global database of how local terrestrial biodiversity responds to human impacts

Biodiversity continues to decline in the face of increasing anthropogenic pressures such as habitat destruction, exploitation, pollution and introduction of alien species. Existing global databases of species’ threat status or population time series are dominated by charismatic species. The collation of datasets with broad taxonomic and biogeographic extents, and that support computation of a range of biodiversity indicators, is necessary to enable better understanding of historical declines and to project – and avert – future declines. We describe and assess a new database of more than 1.6 million samples from 78 countries representing over 28,000 species, collated from existing spatial comparisons of local-scale biodiversity exposed to different intensities and types of anthropogenic pressures, from terrestrial sites around the world. The database contains measurements taken in 208 (of 814) ecoregions, 13 (of 14) biomes, 25 (of 35) biodiversity hotspots and 16 (of 17) megadiverse countries. The database contains more than 1% of the total number of all species described, and more than 1% of the described species within many taxonomic groups – including flowering plants, gymnosperms, birds, mammals, reptiles, amphibians, beetles, lepidopterans and hymenopterans. The dataset, which is still being added to, is therefore already considerably larger and more representative than those used by previous quantitative models of biodiversity trends and responses. The database is being assembled as part of the PREDICTS project (Projecting Responses of Ecological Diversity In Changing Terrestrial Systems – www.predicts.org.uk). We make site-level summary data available alongside this article. The full database will be publicly available in 2015

En modell för beräkning av markens packningskänslighet under vegetationsperioden

This work is a part of a larger project together with Danisco Sugar AB, which tries to prevent compaction in the subsoil when using heavy sugar beet harvesters. The work is based on measuring the water con tent during a growing season (1997) and to calculate the water content with the simulation model SOIL. After that, the water con tent has been simulated from weather data for a longer period, and the risk for compaction in the autumn has been calculated. Agriculture has gone through a lot of changes since the second world war, for example the machines have become larger and heavier. The purpose of the project was to examine how often soil compaction in the subsoil should arise by measuring and calculating the water con tent. We have measured the water content every 14th day during the growing season 1997 on two sites: Elvireborg east of Landskrona and Kronoslätt dose to Hemmesdynge in the very south of Sweden. At Elvireborg sampling was made in sugar beets and spring wheat, and at Kronoslätt in sugar beets and spring barley. The soil at Elvireborg is a sandy day loam with a porosity of 38 % (vol/vol) with 18,4 % (vol/vol) water at permanent wilting point and 15,6 % plant available water. The soil has a good hydraulic conductivity in the topsoil (O - 30 cm), but much lower in the lower part of the subsoil (60-100 cm). During dry summers the hydraulic conductivity will improve by crack formation. Kronoslätt is a sandy loam with a porosity of 36,7 % with 12,6 % (vol/vol) water at permanent wilting point and 20,9 % plant available water. Kronoslätt has a strongly reduced hydraulic conductivity in the subsoil (30 - 100 cm) in comparison with the topsoil (O - 30 cm). An opened cylinder drill or an Ultuna drill was used to take out the soil samples to determine the water content at every 10th centimeter to one meter depth. Soil cores were sampled to one meter depth to determine saturated hydraulic conductivity and soil water retention. The water content was used to calibrate the simulation model (SOIL). Weather data for 1997 was collected from Jordberga sugar factory for Kronoslätt and from Svalöv weather station for Elvireborg. In the simulations the daily mean values were used for temperature, precipitation and sun radiation. Calculations have been done for changes in water content in 1997 and for the period 1963 - 1988 with 1997 as a calibration year. The precompression stress (Casagrande, 1936) was determined at four water tensions, and a logarithmic function was made between precompression stress and water tension. By combining this function with the soil water simulation, the susceptibility to compaction was estimated. The cereal crops took up less water than the sugar beets, and the sugar beets took up water during a longer period of the year, depending on a longer growing season. In the end of July practically all plant available water in the profile had been used in 1997. The measured water con tent was sometimes below permanent wilting point and lower than the simulated values. However, in general there was good correlation between measured and simulated values. Calculations were also made for the vertical soil stress in the soil, for a wheel load of 8 tons and 220 kPa ground contact pressure corresponding to a fully loaded sugar beet harvester. The soil was considered susceptible to compaction when the stress at a certain depth was higher than the precompression stress of the soil at that specific water content. Driving late in the autumn involves a big risk of compaction of the subsoil both at Elvireborg and Kronoslätt. From the middle of October there was a compaction risk in the subsoil at 50 cm depth for half of the years. In the results over the whole year, the Elvireborg site was more susceptible to subsoil compaction than Kronoslätt. This could be due to Kronoslätt being a more compact soil with a higher precompression stress