Maximising learning opportunities in handover

Handing over responsibility for patients has always been part of medical practice. Definitions emphasise transfer of responsibility to ensure patient safety and the available literature tends to follow this line (see box 1). Handover is much more than this, however. It is a key event where teams meet, have the opportunity to communicate, support each other and learn. This paper considers different ways of maximising learning opportunities in handover, with particular emphasis on the strengths and challenges of the paediatric environment. Alongside review of the best available evidence, many of the ideas discussed were generated from working with a group of 65 experienced paediatricians with particular experience and interest in medical education as part of the Royal College of Paediatrics and Child Health Paediatric Educators Programme. Formal handover has increased in importance and been embedded in practice with the transition from “on-calls” to “full-shift” rotas in an effort to comply with the European Working Time Directive1 in the United Kingdom (UK). Departments responsible for acute patient care have had to incorporate two or three handover sessions into every day to ensure patient problems and management plans are appreciated by the incoming medical team

Alien Registration- Macdougall, William R. (Presque Isle, Aroostook County)

https://digitalmaine.com/alien_docs/33385/thumbnail.jp

Assessment of Dietary Behaviors, Body Composition, and Cardiovascular Disease Risk among College Club Rugby Team

International Journal of Exercise Science 8(4): 403-413, 2015. The purpose of this study was to evaluate dietary behaviors, body composition, and potential cardiovascular disease (CVD) risk factors among college club rugby team players. 15 athletes completed demographics, three 24-hour dietary recalls, body composition and blood lipid profile assessments following an overnight fast. Mean ± SD age of participants was 20 ± 1 years; weight 81 ± 16 kg; BMI 25.7 ± 3.2 kg/m2; body fat 13 ± 5%; total cholesterol 133 ± 37 mg/dl; high-density lipoprotein 49 ± 18 mg/dl; low-density lipoproteins 77 ± 26 mg/dl; triglycerides 86 ± 34 mg/dl. The results of dietary analysis indicated that carbohydrates comprise 44 ± 3% (3.2 ± 0.2 g/kg), proteins 21 ± 5% (1.5 ± 0.4 g/kg), and fats 34 ± 3% of the total calories. Mean intake of total fat and saturated fat exceeded recommendations of the Acceptable Macronutrient Distribution Range (AMDR). Recommended Dietary Allowances (RDA) were met for most of the micronutrients excluding vitamin A 557 ± 157 μg/dl (61% RDA) vitamin E 6 ± 0.5 μg/dl (40% RDA) and potassium 2267 ± 613 μg/dl (50% RDA) while mean intake for sodium 4276 ± 437 mg/dl was 285% recommended. In addition, mean intake of fiber 18 ± 5 g was 55% below that recommended. At present, most of the participants were at low risk for developing CVD. However, continuous high intake of total and saturated fat, sodium and low fiber may lead to increased risk for developing CVD

Long-term winter-site fidelity in Song Sparrows (Melospiza melodia)

In migratory animals, the degree to which individuals return to the same wintering sites across multiple years can affect fitness and population dynamics, and thus has important implications for conservation. Despite this, long-term evaluations of wintering-site fidelity are rare for migratory birds: many populations are intensively studied on their breeding grounds but tracking the migratory movements of small birds once they leave the breeding grounds is challenging. To evaluate patterns of overwintering location and fidelity, we collected winter-grown claw tissue from 301 Song Sparrows (Melospiza melodia; 449 samples) captured in spring at their breeding grounds over six consecutive years and assessed stable hydrogen isotope (δ2Hc) values to determine within-individual repeatability and between-year variation in wintering latitudes. We also retrieved useable data from eight geolocators over two consecutive winters. Geolocator-derived wintering positions correlated with origins based on δ2Hc values. Consistent with previous findings, male δ2Hcvalues reflected more northerly wintering areas than those of females, indicating shorter latitudinal migration distances for males, but the magnitude of the sex difference varied across years. The distribution of wintering latitudes was generally consistent among years, except for the 2015 – 2016 winter that had unusually negative δ2Hc values. Values of δ2Hc were repeatable for males but not for females, suggesting that winter-site fidelity could differ between sexes. The data presented here emphasize the importance of tracking migratory populations across multiple years to uncover factors affecting population dynamics

Testosterone, Migration Distance, and Migratory Timing in Song Sparrows Melospiza melodia

In seasonally migratory animals, migration distance often varies substantially within populations such that individuals breeding at the same site may overwinter different distances from the breeding grounds. Shorter migration may allow earlier return to the breeding grounds, which may be particularly advantageous to males competing to acquire a breeding territory. However, little is known about potential mechanisms that may mediate migration distance. We investigated naturally-occurring variation in androgen levels at the time of arrival to the breeding site and its relationship to overwintering latitude in male and female song sparrows (Melospiza melodia). We used stable isotope analysis of hydrogen (δ2H) in winter-grown claw tissue to infer relative overwintering latitude (migration distance), combined with 14 years of capture records from a long-term study population to infer the arrival timing of males versus females. Relative to females, males had higher circulating androgen levels, migrated shorter distances, and were more likely to be caught early in the breeding season. Males that migrate short distances may benefit from early arrival at the breeding grounds, allowing them to establish a breeding territory. Even after controlling for sex and date, androgen levels were highest in individuals that migrated shorter distances. Our findings indicate that androgens and migration distance are correlated traits within and between sexes that may reflect individual variation within an integrated phenotype in which testosterone has correlated effects on behavioral traits such as migration

Medical graduate views on statistical learning needs for clinical practice: a comprehensive survey

BACKGROUND: This paper seeks to contribute to a reputable evidence base for required competencies across different topics in statistics and probability (statistical topics) in preparing medical graduates for clinical practice. This is in order to inform the prioritization of statistical topics within future undergraduate medical curricula, while exploring the need for preparing tomorrow's doctors to be producers, and not merely consumers, of statistics. METHODS: We conducted a comprehensive online survey from July 2013 to August 2014 for a target group of 462 medical graduates with current or prior experience of teaching undergraduate medical students of the University of Edinburgh of whom 278 (60.2%) responded. Statistical topics were ranked by proportion of respondents who identified the practice of statistics, performing statistical procedures or calculations using appropriate data, as a required competency for medical schools to provide in preparing undergraduate medical students for clinical practice. Mixed effects analyses were used to identify potential predictors for selection of the above competency and to compare the likelihood of this selection for a range of statistical topics versus critical appraisal. RESULTS: Evidence was gleaned from medical graduates' experiences of clinical practice for the need for, not only a theoretical understanding of statistics and probability but also, the ability to practice statistics. Nature of employment and statistical topic were highly significant predictors of choice of the practice of statistics as a required competency ((F = 3.777, p < 0.0005) and (F = 45.834, p < 0.0005), respectively). The most popular topic for this competency was graphical presentation of data (84.3% of respondents) in contrast to cross-over trials for the competency understanding the theory only (70.5% of respondents). Several topics were found to be more popular than critical appraisal for competency in the practice of statistics. CONCLUSIONS: The model of medical graduates as mere consumers of statistics is oversimplified. Contrary to what has been suggested elsewhere, statistical learning opportunities in undergraduate medicine should not be restricted to development of critical appraisal skills. Indeed, our findings support development of learning opportunities for undergraduate medical students as producers of statistics across a wide range of statistical topics