Using the Plan-Do-Study-Act (PDSA) Model for Continuous Quality Improvement of an Established Simulated Patient Program

Objective: To describe the use of a continuous quality improvement process for strengthening our simulated patient (SP) program and the initial steps that have been implemented.  Innovation: A workgroup that included five clinical faculty with significant experience working with SPs and a strong interest in improving the SP program was developed.  The Plan-Do-Study-Act model was used as it allowed for incremental quality improvement changes, in order to ensure a high-quality SP program designed to optimize student learning.  Data were gathered from students, SPs, and faculty. Opportunities for improvement were prioritized based on anticipated benefits and available resources.  Changes related to planning, implementation, and evaluation and feedback have been executed. Critical Analysis: Changes related to planning that were implemented included developing handbooks for SPs, faculty, and graduate student instructors, as well as material for students in order to better describe the program.  SPs are now referred to as “simulated” as opposed to “standardized” as part of a broader effort to clarify the purpose of SP interactions to students.  Streamlined rubrics have been piloted, including electronic rubrics for first year students.  SPs are being trained on fewer cases, in order to improve the training program.  When possible, activities now take place in one large classroom instead of many small classrooms to improve oversight.  Finally, additional feedback has been obtained from SPs via a retreat.  These changes have been well received by students, SPs, and faculty.    Next Steps: The collection of this data and initial quality improvement changes provided a basis for hiring a full-time employee who will: dedicate 50% of their time to programmatic assessment of the SP program, support faculty with logistics and training, and be the face of our program to the students and SPs. Further, formal quantitative and qualitative assessment of the SP program has begun.   Type:  Not

Discovery and Follow-up Observations of the Young Type Ia Supernova 2016coj

The Type~Ia supernova (SN~Ia) 2016coj in NGC 4125 (redshift $z=0.004523$) was discovered by the Lick Observatory Supernova Search 4.9 days after the fitted first-light time (FFLT; 11.1 days before $B$-band maximum). Our first detection (pre-discovery) is merely $0.6\pm0.5$ day after the FFLT, making SN 2016coj one of the earliest known detections of a SN Ia. A spectrum was taken only 3.7 hr after discovery (5.0 days after the FFLT) and classified as a normal SN Ia. We performed high-quality photometry, low- and high-resolution spectroscopy, and spectropolarimetry, finding that SN 2016coj is a spectroscopically normal SN Ia, but with a high velocity of \ion{Si}{2} $\lambda$6355 ($\sim 12,600$\,\kms\ around peak brightness). The \ion{Si}{2} $\lambda$6355 velocity evolution can be well fit by a broken-power-law function for up to a month after the FFLT. SN 2016coj has a normal peak luminosity ($M_B \approx -18.9 \pm 0.2$ mag), and it reaches a $B$-band maximum \about16.0~d after the FFLT. We estimate there to be low host-galaxy extinction based on the absence of Na~I~D absorption lines in our low- and high-resolution spectra. The spectropolarimetric data exhibit weak polarization in the continuum, but the \ion{Si}{2} line polarization is quite strong ($\sim 0.9\% \pm 0.1\%$) at peak brightness.Comment: Submitte

Long-term Optical Variability of Radio-Selected Quasars from the FIRST Survey

We have obtained single-epoch optical photometry for 201 quasars, taken from the FIRST Bright Quasar Survey, which span a wide range in radio loudness. Comparison with the magnitudes of these objects on the POSS-I plates provides by far the largest sample of long-term variability amplitudes for radio-selected quasars yet produced. We find the quasars to be more variable in the blue than in the red band, consistent with work on optically selected samples. The previously noted trend of decreasing variability with increasing optical luminosity applies only to radio-quiet objects. Furthermore, we do not confirm a rise in variability amplitude with redshift, nor do we see any dependence on radio flux or luminosity. The variability over a radio-optical flux ratio range spanning a factor of 60,000 from radio-quiet to extreme radio-loud objects is largely constant, although there is a suggestion of greater variability in the extreme radio-loud objects. We demonstrate the importance of Malmquist bias in variability studies, and develop a procedure to correct for the bias in order to reveal the underlying variability properties of the sample.Comment: 16 pages, 8 figures To be published in 2001 April 1 Astronomical Journa

What Does the Geometry of the HβBLR Depend On?

We combine our dynamical modeling black-hole mass measurements from the Lick AGN Monitoring Project 2016 sample with measured cross-correlation time lags and line widths to recover individual scale factors, f, used in traditional reverberation-mapping analyses. We extend our sample by including prior results from Code for AGN Reverberation and Modeling of Emission Lines (CARAMEL) studies that have utilized our methods. Aiming to improve the precision of black-hole mass estimates, as well as uncover any regularities in the behavior of the broad-line region (BLR), we search for correlations between f and other AGN/BLR parameters. We find (i) evidence for a correlation between the virial coefficient log10(fmean,σ) and black-hole mass, (ii) marginal evidence for a similar correlation between log10( frms,σ) and black-hole mass, (iii) marginal evidence for an anticorrelation of BLR disk thickness with log10( fmean,FWHM) and log10( frms,FWHM), and (iv) marginal evidence for an anticorrelation of inclination angle with log10( fmean,FWHM), log10( frms,σ), and log10( fmean,σ). Last, we find marginal evidence for a correlation between line-profile shape, when using the root-mean-square spectrum, log10(FWHM/σ)rms, and the virial coefficient, log10( frms,σ), and investigate how BLR properties might be related to line-profile shape using CARAMEL models

The Sorcerer II Global Ocean Sampling Expedition: Northwest Atlantic through Eastern Tropical Pacific

The world's oceans contain a complex mixture of micro-organisms that are for the most part, uncharacterized both genetically and biochemically. We report here a metagenomic study of the marine planktonic microbiota in which surface (mostly marine) water samples were analyzed as part of the Sorcerer II Global Ocean Sampling expedition. These samples, collected across a several-thousand km transect from the North Atlantic through the Panama Canal and ending in the South Pacific yielded an extensive dataset consisting of 7.7 million sequencing reads (6.3 billion bp). Though a few major microbial clades dominate the planktonic marine niche, the dataset contains great diversity with 85% of the assembled sequence and 57% of the unassembled data being unique at a 98% sequence identity cutoff. Using the metadata associated with each sample and sequencing library, we developed new comparative genomic and assembly methods. One comparative genomic method, termed “fragment recruitment,” addressed questions of genome structure, evolution, and taxonomic or phylogenetic diversity, as well as the biochemical diversity of genes and gene families. A second method, termed “extreme assembly,” made possible the assembly and reconstruction of large segments of abundant but clearly nonclonal organisms. Within all abundant populations analyzed, we found extensive intra-ribotype diversity in several forms: (1) extensive sequence variation within orthologous regions throughout a given genome; despite coverage of individual ribotypes approaching 500-fold, most individual sequencing reads are unique; (2) numerous changes in gene content some with direct adaptive implications; and (3) hypervariable genomic islands that are too variable to assemble. The intra-ribotype diversity is organized into genetically isolated populations that have overlapping but independent distributions, implying distinct environmental preference. We present novel methods for measuring the genomic similarity between metagenomic samples and show how they may be grouped into several community types. Specific functional adaptations can be identified both within individual ribotypes and across the entire community, including proteorhodopsin spectral tuning and the presence or absence of the phosphate-binding gene PstS

Evolutionary and biomedical insights from the rhesus macaque genome

The rhesus macaque (Macaca mulatta) is an abundant primate species that diverged from the ancestors of Homo sapiens about 25 million years ago. Because they are genetically and physiologically similar to humans, rhesus monkeys are the most widely used nonhuman primate in basic and applied biomedical research. We determined the genome sequence of an Indian-origin Macaca mulatta female and compared the data with chimpanzees and humans to reveal the structure of ancestral primate genomes and to identify evidence for positive selection and lineage-specific expansions and contractions of gene families. A comparison of sequences from individual animals was used to investigate their underlying genetic diversity. The complete description of the macaque genome blueprint enhances the utility of this animal model for biomedical research and improves our understanding of the basic biology of the species

The Lick AGN Monitoring Project 2016 : velocity-resolved Hβ lags in luminous Seyfert galaxies

Funding: K.H. acknowledges support from STFC grant ST/R000824/1.We carried out spectroscopic monitoring of 21 low-redshift Seyfert 1 galaxies using the Kast double spectrograph on the 3 m Shane telescope at Lick Observatory from April 2016 to May 2017. Targetingactive galactic nuclei (AGN) with luminosities of λLλ(5100 Å) ≈ 1044 erg s−1 and predicted Hβ lags of∼ 20–30 days or black hole masses of 107–108.5 M⊙, our campaign probes luminosity-dependent trends in broad-line region (BLR) structure and dynamics as well as to improve calibrations for single-epoch estimates of quasar black hole masses. Here we present the first results from the campaign, including Hβ emission-line light curves, integrated Hβ lag times (8–30 days) measured against V -band continuum light curves, velocity-resolved reverberation lags, line widths of the broad Hβ components, and virial black hole mass estimates (107.1–108.1 M⊙). Our results add significantly to the number of existing velocity-resolved lag measurements and reveal a diversity of BLR gas kinematics at moderately high AGN luminosities. AGN continuum luminosity appears not to be correlated with the type of kinematics that its BLR gas may exhibit. Follow-up direct modeling of this dataset will elucidate the detailed kinematics and provide robust dynamical black hole masses for several objects in this sample.Publisher PDFPeer reviewe

The Lick AGN Monitoring Project 2016 : dynamical modeling of velocity-resolved Hβ lags in luminous Seyfert galaxies

K.H. acknowledges support from STFC grant ST/R000824/1.We have modeled the velocity-resolved reverberation response of the Hβ broad emission line in nine Seyfert 1 galaxies from the Lick Active Galactic Nucleus (AGN) Monitoring Project 2016 sample, drawing inferences on the geometry and structure of the low-ionization broad-line region (BLR) and the mass of the central supermassive black hole. Overall, we find that the Hβ BLR is generally a thick disk viewed at low to moderate inclination angles. We combine our sample with prior studies and investigate line-profile shape dependence, such as log10(FWHM/σ), on BLR structure and kinematics and search for any BLR luminosity-dependent trends. We find marginal evidence for an anticorrelation between the profile shape of the broad Hβ emission line and the Eddington ratio, when using the rms spectrum. However, we do not find any luminosity-dependent trends, and conclude that AGNs have diverse BLR structure and kinematics, consistent with the hypothesis of transient AGN/BLR conditions rather than systematic trends.Publisher PDFPeer reviewe