Have First-Year Emergency Medicine Residents Achieved Level 1 on Care-Based Milestones?

BACKGROUND: Residents in Accreditation Council for Graduate Medical Education accredited emergency medicine (EM) residencies were assessed on 23 educational milestones to capture their progression from medical student level (Level 1) to that of an EM attending physician (Level 5). Level 1 was conceptualized to be at the level of an incoming postgraduate year (PGY)-1 resident; however, this has not been confirmed. OBJECTIVES: Our primary objective in this study was to assess incoming PGY-1 residents to determine what percentage achieved Level 1 for the 8 emergency department (ED) patient care-based milestones (PC 1-8), as assessed by faculty. Secondary objectives involved assessing what percentage of residents had achieved Level 1 as assessed by themselves, and finally, we calculated the absolute differences between self- and faculty assessments. METHODS: Incoming PGY-1 residents at 4 EM residencies were assessed by faculty and themselves during their first month of residency. Performance anchors were adapted from ACGME milestones. RESULTS: Forty-one residents from 4 programs were included. The percentage of residents who achieved Level 1 for each subcompetency on faculty assessment ranged from 20% to 73%, and on self-assessment from 34% to 92%. The majority did not achieve Level 1 on faculty assessment of milestones PC-2, PC-3, PC-5a, and PC-6, and on self-assessment of PC-3 and PC-5a. Self-assessment was higher than faculty assessment for PC-2, PC-5b, and PC-6. CONCLUSIONS: Less than 75% of PGY-1 residents achieved Level 1 for ED care-based milestones. The majority did not achieve Level 1 on 4 milestones. Self-assessments were higher than faculty assessments for several milestones

Encouraging versatile thinking in algebra using the computer

In this article we formulate and analyse some of the obstacles to understanding the notion of a variable, and the use and meaning of algebraic notation, and report empirical evidence to support the hypothesis that an approach using the computer will be more successful in overcoming these obstacles. The computer approach is formulated within a wider framework ofversatile thinking in which global, holistic processing complements local, sequential processing. This is done through a combination of programming in BASIC, physical activities which simulate computer storage and manipulation of variables, and specific software which evaluates expressions in standard mathematical notation. The software is designed to enable the user to explore examples and non-examples of a concept, in this case equivalent and non-equivalent expressions. We call such a piece of software ageneric organizer because if offers examples and non-examples which may be seen not just in specific terms, but as typical, or generic, examples of the algebraic processes, assisting the pupil in the difficult task of abstracting the more general concept which they represent. Empirical evidence from several related studies shows that such an approach significantly improves the understanding of higher order concepts in algebra, and that any initial loss in manipulative facility through lack of practice is more than made up at a later stage

Uszkodzenie nadnerczy w następstwie tępych urazów: wskaźnik ciężkości doznanych obrażeń

Introduction: Adrenal gland injuries (AGI) are seen increasingly frequently owing to advances in modern imaging techniques. This study describes a series of patients with blunt AGI, with the emphasis on AGI as a marker of injury severity, CT-radiographic classification of AGI and associated injury patterns. Material and methods: A retrospective review of blunt trauma patients with AGI was performed. Variables examined included demographics, mechanism of injury, length of hospital and ICU stay, clinical status on admission, AGI characteristics, associated injuries, complications, procedures, mortality and discharge disposition. Results: There were 29 AGI patients with a mean injury severity score of 25. The most common injury mechanisms were motor-vehicular collisions (15/29) and falls (5/29). Right-sided AGI (16/29) outnumbered left-sided (12/29) injuries. The most common CT-radiographic types of AGI were adrenal gland contusions and lacerations with limited "blush". While patterns of injuries differed between right and left-sided AGI, the mean number of injuries did not. The most common associated injuries included extremity (21/29), rib (20/29) and spinal fractures (18/29). Common procedures included orthopaedic fixation (10/29), vena cava filter (8/29) and tracheostomy (5/29). A median of two complications per patient was reported, including adrenal insufficiency in two patients. Mortality was 17%. The median hospital and ICU length of stay were 15 and 12 days, respectively. Conclusions: Adrenal gland injury is associated with significant morbidity and mortality. With modern imaging modalities capable of reliably detecting adrenal injury, the presence of AGI should be considered a marker of overall injury severity. The authors provide a CT-radiographic classification of adrenal injuries.Wstęp: W związku z postępem w zakresie nowoczesnych metod obrazowania coraz częściej stwierdza się uszkodzenia nadnerczy (AGI, adrenal gland injuries). W tym badaniu opisano grupę chorych, którzy doznali uszkodzenia nadnerczy w wyniku tępego urazu. Zwrócono szczególną uwagę na AGI jako wskaźnik ciężkości odniesionych obrażeń, klasyfikację AGI na podstawie tomografii komputerowej i charakter współistniejących obrażeń. Materiał i metody: Przeprowadzono retrospektywną analizę danych pacjentów, którzy doznali AGI w wyniku tępego urazu. W badaniu uwzględniono dane demograficzne, mechanizm powstania urazu, czas hospitalizacji oraz pobytu na oddziale intensywnej opieki medycznej, stan kliniczny w chwili przyjęcia do szpitala, cechy AGI, doznane obrażenia, powikłania, zastosowane procedury medyczne, odsetek zgonów i dalsze postępowanie. Wyniki: Do badania włączono 29 osób z AGI, u których średnia ocena ciężkości obrażeń wynosiła 25. Najczęstszymi przyczynami urazu były wypadki motocyklowe (15/29) i upadki (5/29). Liczba prawostronnych AGI (16/29) była wyższa niż liczba uszkodzeń lewostronnych (12/29). Najczęściej stwierdzanym rodzajem uszkodzeń AGI w badaniu tomograficznym było stłuczenie i rozdarcie narządu z niewielkim krwawieniem. Chociaż charakter uszkodzeń różnił się w zależności od prawo- lub lewostronnej lokalizacji AGI, średnia liczba uszkodzeń była taka sama. Najczęstszymi współwystępującymi obrażeniami były złamania kończyn (21/29), żeber (20/29) i kręgów (18/29). Do najczęściej wykonywanych procedur należały: unieruchomienie ortopedyczne (10/29), wszczepienie filtra do żyły głównej (8/29) i tracheostomia (5/29). Mediana liczby powikłań u poszczególnych chorych wynosiła 2 (włączając niewydolność nadnerczy u 2 osób). Odsetek zgonów wynosił 17%. Mediana okresu hospitalizacji i pobytu na oddziale intensywnej opieki medycznej wynosiła odpowiednio 15 i 12 dni. Wnioski: Uszkodzenie nadnerczy wiąże się ze znaczną chorobowością i śmiertelnością. Dostępne obecnie nowoczesne metody obrazowania umożliwiają wykrycie uszkodzeń nadnerczy. Należałoby rozważyć przyjęcie obecności AGI jako markera ciężkości doznanych obrażeń. Autorzy przedstawili klasyfikację uszkodzeń nadnerczy na podstawie badań tomograficznych

Seniors' experiences of living in special housing accommodation

This article presents a hermeneutic phenomenological analysis of interview material in which 12 seniors living in Special Housing Accommodation (SHA) facilities reflect on the experience of living in such facilities. Of particular interest in the analysis is living in a SHA as a phenomenon. The finding shows that the phenomenon of lived experience in a SHA seems to be a state of ambiguity regarding one's existence, which is made up of several constituents (elements of meaning). The analysis contributes to the understanding of how the phenomenon of SHA living is coming into existence as a need, due to an individual's failing health; however, the SHA is not considered to be a true home. Accordingly, this has consequences to the subject position for the seniors in that they have to navigate between existing and not existing. The seniors learn to cope with living in the SHA by lowering their expectations of life and existence while the SHA provides the prerequisites for their existence. An implication for promoting care is to support the seniors to enable a full existence of life within SHA living

Produção de memórias falsas com listas de associados : análise do efeito do nível de processamento e da natureza da prova de memória

As memórias falsas têm sido amplamente estudadas com base num procedimento experimental designado paradigma DRM (Deese/Roediger/McDermott). Esse paradigma promove a criação de ilusões de memória a partir da apresentação de listas de palavras associadas a um item que não consta da lista. Uma das linhas de investigação com o paradigma DRM visa identificar o momento da criação das falsas memórias e explicar os mecanismos que estão na sua origem. Neste artigo, pretendemos fazer uma revisão da investigação sobre o efeito do nível de processamento e da natureza da tarefa de memória na facilitação ou inibição da produção de memórias falsas com listas de associados semânticos.False memories have been widely studied using an experimental procedure called DRM paradigm (Deese/Roediger/McDermott). This paradigm produces memory illusions due to the presentation of lists of words associated to a critical nonpresented word. One line of research on this topic aims at identifying the moment when the false memories are created and the explanation of the mechanisms underling false memories. In this paper we present a review about the effect of level-of-processing and the nature of memory task for the boost or inhibition of false memories created by means of lists of semantic associates.Le paradigme DRM (Deese/Roediger/McDermott) est un des plus connus et plus robustes parmi les études des faux mémoires dans le contexte du laboratoire. Ce paradigme permet la création d illusions de mémoire à partir des mots sémantiquement associés à un item qui n a pas été présenté. Au milieu des investigations basées sur le paradigme DRM il y a des études dont l objectif est d identifier e d´expliquer les mécanismes qui sont à l origine de la production des faux mémoires. Plus spécifiquement, on a pour but de faire une révision de la recherche sur l effet du niveau de codification et de la nature des tâches de mémoire sur la facilitation ou l´inhibition de la production de faux mémoires à partir des mots sémantiquement associés.Los falsos recuerdos han sido muy estudiados mediante la aplicación del paradigma DRM (Deese/Roediger/McDermott). El paradigma permite producir ilusiones de memoria tras la presentación de listas de palabras asociadas a una palabra que no se incluye en la lista. Una de las líneas de investigación que utilizan el paradigma DRM busca identificar el preciso momento de la creación de falsos recuerdos y explicar los mecanismos que originan ese efecto. El objetivo de este artículo es hacer una revisión de la investigación sobre el efecto de los niveles de procesamiento y la naturaleza de la tarea de memoria en la facilitación y inhibición de la producción de falsos recuerdos con listas de asociados semánticos.Fundação para a Ciência e a Tecnologia (FCT)Centro de Investigação em Psicologia da Universidade do Minho (CIPsi

Habit, Memory, and the Persistence of Socialist-Era Street Names in Postsocialist Bucharest, Romania

The critical study of toponymy has paid considerable attention to the renaming of urban places following revolutionary political change. Such renaming is intended to institutionalize a new political agenda through shaping the meanings in everyday practices and landscapes. Renaming, however, might not always be successful, and this article examines this issue with reference to a market in Bucharest, Romania. Originally named Piaţa Moghioroş during the socialist era to commemorate a leading Communist Party activist, the market was renamed in the postsocialist period. Yet, more than two decades on, the original name remains in widespread everyday use. Using a mixed-method approach, we seek to advance the critical toponymies literature by exploring the persistence of the socialist-era name within everyday practice. Although many authors have highlighted the issue of popular resistance to an unpopular renaming, we find little evidence of conscious resistance, and instead we explore the importance of habit within everyday practices as an explanation, drawing on an understanding of habit derived from sociocognitive psychology. This perspective proposes that habits are stable and hard to break if the broader context in which they are situated is stable. We suggest that this explanation, rather than popular contestation, has more to offer in understanding the persistence of the toponym Piaţa Moghioroş. We thus highlight the importance of considering how the “users” of place names react to the changes of such names and create their own meanings in relation to them in ways unintended by elites

Rhythmanalysing marathon running: ‘A drama of rhythms’

© 2017, © The Author(s) 2017. This paper draws on Lefebvre’s rhythmanalysis to investigate the multiple rhythms of the Berlin Marathon, exemplifying and expanding understandings about the rhythms of places and mobilities. First, we discuss how isorhythmic order is imposed on the city and event by race organizers. Secondly, we show that a marathon depends upon the preparatory training or ‘dressage’ performed by the thousands who have made themselves ‘race-ready’. Thirdly, we explore the changing individual and collective rhythms that continuously emerge according to contingencies and stages of the race to compose an unfolding drama of rhythms that includes both arrhythmic and eurhythmic experiences

Portuguese category norms for children

This study presents Portuguese category norms for children of three different age groups: preschoolers (3- to 4-year-olds), second graders (7- to 8-year-olds), and preadolescents (11- to 12-year-olds). Three hundred Portuguese children (100 in each group) completed an exemplar-generation task. Preschoolers generated exemplars for 13 categories, second graders generated exemplars for 17 categories, and preadolescents generated exemplars for 21 categories. For each group, responses within each category were organized according to frequency of production in order to derive exemplar-production norms for sets of tested categories. The results also included information about the number of responses and exemplars, idiosyncratic and inappropriate responses, and commonality and diversity indexes for all the categories. A comparison of these children’s norms with the Portuguese adult norms was also presented. The full set of norms may be downloaded from www.psychonomic.org/archive