Active-Learning Quality Improvement Training Curriculum for Faculty in Hospital Medicine

Background: There is a growing emphasis on teaching Quality Improvement (QI) to resident physicians and medical students. However, faculty with QI skills and knowledge is lacking at many academic medical centers.Active learning programs to improve faculty capacity for QI have shown positive outcomes. We sought to develop a QI curriculum for faculty within the Division of Hospital Medicine. Description of project/program/innovation: We conducted a needs assessment focus group for Hospital Medicine faculty at our academic medical center. Six faculty members participated and identified priorities and potential challenges. Based on the focus group feedback, we designed a 12-session curriculum that uses an active-learning approach to teach core concepts in QI and includes sessions on effectively mentoring and publishing QI (Table 1). Junior and senior faculty collaborated on curricular design and delivery, with the goal of developing junior faculty into effective QI teachers. Pre-assessment of QI knowledge, skills, and attitudes was conducted using a survey instrument and the revised Quality Improvement Knowledge Application Tool (QIKAT-R). Results: Eighteen faculty completed the pre-assessments (82% completion). At baseline, self-reported comfort was highest for “setting aims for a QI project” and lowest for “presenting results of a QI project”. The mean QIKAT-R score was 16.8 out of 27 (SD 4.5), with the lowest performance in the “setting aims” domain. To date, six sessions have been completed. The selected project focuses on improving hospitalized patients’ experiences around daily bedside rounding. Discussion: We have created a QI curriculum that seeks to address the gap in QI skills among hospitalists. Pre-assessments revealed poor correlation between self-reported comfort level and QIKAT-R scores within each domain, further highlighting educational opportunities. We plan to use feedback from this pilot to refine the curriculum and offer it to faculty in other specialties

Systematic distortions in musicians' reproduction of cyclic three-interval rhythms

In a classic study, Fraisse (1956) demonstrated that sequences of four sounds defining three different interval durations exhibit characteristic distortions in reproduction: The two more similar intervals tend to be assimilated to each other, resulting in a rhythm containing just two interval durations. The present study examined whether highly trained musicians (including percussionists) are able to perform such rhythms accurately in a synchronization-continuation tapping paradigm. Eleven rhythms, a subset of those used by Fraisse, were presented cyclically at his original tempo and also at a slower tempo. The musicians produced significant rhythm distortions, though they were smaller than those observed by Fraisse and not always assimilative. They were relatively larger at the fast than at the slow tempo and occurred in both synchronization and continuation. In contrast to Fraisse’s data, the most variably reproduced target rhythm was the one in which the two longer intervals were identical. The pattern of distortions suggested attraction towards ideal rhythms in which all three interval durations are different, representing metrical categories with nominally simple interval ratios (some permutation of 1:2:3) that were probably activated by the cyclic presentation of the rhythms. However, these attractors themselves seemed to be somewhat distorted, perhaps reflecting the simultaneous presence of a nonmetrical attractor that differentiated two interval categories regardless of ratio, as observed by Fraisse

Synchronization to a bouncing ball with a realistic motion trajectory

Daily music experience involves synchronizing movements in time with a perceived periodic beat. It has been established for over a century that beat synchronization is less stable for the visual than for the auditory modality. This auditory advantage of beat synchronization gives rise to the hypotheses that the neural and evolutionary mechanisms underlying beat synchronization are modality-specific. Here, however, we found that synchronization to a periodically bouncing ball with a realistic motion trajectory was not less stable than synchronization to an auditory metronome. This finding challenges the auditory advantage of beat synchronization, and has important implications for the understanding of the biological substrates of beat synchronization

A filled duration illusion in music: Effects of metrical subdivision on the perception and production of beat tempo.

This study replicates and extends previous findings suggesting that metrical subdivision slows the perceived beat tempo (Repp, 2008). Here, musically trained participants produced the subdivisions themselves and were found to speed up, thus compensating for the perceived slowing. This was shown in a synchronization-continuation paradigm (Experiment 1) and in a reproduction task (Experiment 2a). Participants also judged the tempo of a subdivided sequence as being slower than that of a preceding simple beat sequence (Experiment 2b). Experiment 2 also included nonmusician participants, with similar results. Tempo measurements of famous pianists’ recordings of two variation movements from Beethoven sonatas revealed a strong tendency to play the first variation (subdivided beats) faster than the theme (mostly simple beats). A similar tendency was found in musicians’ laboratory performances of a simple theme and variations, despite instruc-tions to keep the tempo constant (Experiment 3a). When playing melodic sequences in which only one of three beats per measure was subdivided, musicians tended to play these beats faster and to perceive them as longer than adjacent beats, and they played the whole sequence faster than a sequence without any subdivisions (Experiments 3b and 3c). The results amply demonstrate a filled duration illusion in rhythm perception and music performance: Intervals containing events seem longer than empty intervals and thus must be shortened to be perceived as equal in duration

Diagnostic Medical Errors: Patient\u27s Perspectives on a Pervasive Problem

Introduction. The Institute of Medicine defines diagnostic error as the failure to establish an accurate or timely explanation for the patient\u27s health problem(s), or effectively communicate the explanation to the patient. To our knowledge, no studies exist characterizing diagnostic error from patient perspectives using this definition. Objective. We sought to characterize diagnostic errors experienced by patients and describe patient perspectives on causes, impacts, and prevention strategies. Methods. We screened 77 adult inpatients at University of Vermont Medical Center and conducted 27 structured interviews with patients who experienced diagnostic error in the past five years. We performed qualitative analysis using Grounded Theory. Results. In the past five years, 39% of interviewed patients experienced diagnostic error. The errors mapped to the following categories: accuracy (30%), communication (34%) and timeliness (36%). Poor communication (13 responses) and inadequate time with doctors (7) were the most identified causes of errors. Impacts of errors included emotional distress (17 responses), adverse health outcomes (7) and impaired activities of daily living (6). Patients suggested improved communication (11 responses), clinical management (7) and access to doctors (5) as prevention strategies. For communication, patients rated talk to your doctor highest (mean 8.4, on 1-10 Likert scale) and text message lowest (4.8). Conclusions/Recommendations. Diagnostic errors are common and have dramatic impact on patients\u27 well-being. We suggest routine surveillance to identify errors, support for patients who have experienced errors, and implementation of patient and provider checklists to enhance communication. Future studies should investigate strategies to allow care providers adequate time with patients.https://scholarworks.uvm.edu/comphp_gallery/1246/thumbnail.jp

Exploring agency and self-other processing: an FMRI study of dynamic cooperation using an adaptively paced finger tapping task with variable auditory feedback

Ensemble musicians must be flexible and learn to adapt their performance to that of their partners and do so appropriately based on available sensory information streams. To further describe this type of dynamic joint action, we present a functional MRI study of sensorimotor synchronization with an adaptive “virtual partner” (VP). In particular, we investigate the behavioural and neural effects of variable auditory feedback (off, different to or same as pacing tones) associated with finger tapping performance across varying degrees of VP adaptivity (α). We predict that auditory feedback will bias the system to either i) integrate or ii) segregate information regarding “self” or the VP (“other”). We acquired subjective ratings of sense of oneness (self-other merging) and influence (self-other distinction) which we expected to vary with the availability and reliability (ambiguous-same vs. distinct-different) of pertinent auditory information. Behavioural data show a significant interaction effect of auditory feedback on α and synchronization such that distinctive self-other auditory information results in improvements in synchronization, especially at higher levels of α. Furthermore, auditory feedback was seen to have a significant effect on perceived oneness. Specifically, improved synchronization correlates with both ratings of oneness and activation of the precuneus and posterior cingulate, areas thought to integrate external and self generated information. By contrast, a comparison of neural activation in different and same auditory conditions reveals SMA and cerebellum activity. Identification of these structures may be related to greater sensitivity to prediction error as well as self-other distinction necessary for agency processing

Tunable magnetic properties of arrays of Fe(110) nanowires grown on kinetically-grooved W(110) self-organized templates

We report a detailed magnetic study of a new type of self-organized nanowires disclosed briefly previously [B. Borca et al., Appl. Phys. Lett. 90, 142507 (2007)]. The templates, prepared on sapphire wafers in a kinetically-limited regime, consist of uniaxially-grooved W(110) surfaces, with a lateral period here tuned to 15nm. Fe deposition leads to the formation of (110) 7 nm-wide wires located at the bottom of the grooves. The effect of capping layers (Mo, Pd, Au, Al) and underlayers (Mo, W) on the magnetic anisotropy of the wires was studied. Significant discrepancies with figures known for thin flat films are evidenced and discussed in terms of step anisotropy and strain-dependent surface anisotropy. Demagnetizing coeffcients of cylinders with a triangular isosceles cross-section have also been calculated, to estimate the contribution of dipolar anisotropy. Finally, the dependence of magnetic anisotropy with the interface element was used to tune the blocking temperature of the wires, here from 50K to 200 K

The effects of delayed auditory and visual feedback on speech production

Monitoring the sensory consequences of articulatory movements supports speaking. For example, delaying auditory feedback of a speaker's voice disrupts speech production. Also, there is evidence that this disruption may be decreased by immediate visual feedback, i.e., seeing one's own articulatory movements. It is, however, unknown whether delayed visual feedback affects speech production in fluent speakers. Here, the effects of delayed auditory and visual feedback on speech fluency (i.e., speech rate and errors), vocal control (i.e., intensity and pitch), and speech rhythm were investigated. Participants received delayed (by 200 ms) or immediate auditory feedback, while repeating sentences. Moreover, they received either no visual feedback, immediate visual feedback, or delayed visual feedback (by 200, 400, and 600 ms). Delayed auditory feedback affected fluency, vocal control, and rhythm. Immediate visual feedback had no effect on any of the speech measures when it was combined with delayed auditory feedback. Delayed visual feedback did, however, affect speech fluency when it was combined with delayed auditory feedback. In sum, the findings show that delayed auditory feedback disrupts fluency, vocal control, and rhythm and that delayed visual feedback can strengthen the disruptive effect of delayed auditory feedback on fluency

Cognitive loading affects motor awareness and movement kinematics but not locomotor trajectories during goal-directed walking in a virtual reality environment.

The primary purpose of this study was to investigate the effects of cognitive loading on movement kinematics and trajectory formation during goal-directed walking in a virtual reality (VR) environment. The secondary objective was to measure how participants corrected their trajectories for perturbed feedback and how participants' awareness of such perturbations changed under cognitive loading. We asked 14 healthy young adults to walk towards four different target locations in a VR environment while their movements were tracked and played back in real-time on a large projection screen. In 75% of all trials we introduced angular deviations of ±5° to ±30° between the veridical walking trajectory and the visual feedback. Participants performed a second experimental block under cognitive load (serial-7 subtraction, counter-balanced across participants). We measured walking kinematics (joint-angles, velocity profiles) and motor performance (end-point-compensation, trajectory-deviations). Motor awareness was determined by asking participants to rate the veracity of the feedback after every trial. In-line with previous findings in natural settings, participants displayed stereotypical walking trajectories in a VR environment. Our results extend these findings as they demonstrate that taxing cognitive resources did not affect trajectory formation and deviations although it interfered with the participants' movement kinematics, in particular walking velocity. Additionally, we report that motor awareness was selectively impaired by the secondary task in trials with high perceptual uncertainty. Compared with data on eye and arm movements our findings lend support to the hypothesis that the central nervous system (CNS) uses common mechanisms to govern goal-directed movements, including locomotion. We discuss our results with respect to the use of VR methods in gait control and rehabilitation

Implication of the overlap representation for modelling generalized parton distributions

Based on a field theoretically inspired model of light-cone wave functions, we derive valence-like generalized parton distributions and their double distributions from the wave function overlap in the parton number conserved s-channel. The parton number changing contributions in the t-channel are restored from duality. In our construction constraints of positivity and polynomiality are simultaneously satisfied and it also implies a model dependent relation between generalized parton distributions and transverse momentum dependent parton distribution functions. The model predicts that the t-behavior of resulting hadronic amplitudes depends on the Bjorken variable x_Bj. We also propose an improved ansatz for double distributions that embeds this property.Comment: 15 pages, 8 eps figure