Simulation in clinical education: a reflective and critical account

Simulation. A complex tool employed to immerse learners in a reality created specifically to elicit actions, behaviours and thought processes which can then be discussed with peers and reflected upon by the learner immediately and at leisure. This was my understanding of what simulation has to offer as an educational intervention. I viewed simulation through the lens of Honey and Mumford's (1986) experiential learning typology, seeing it satisfy all four learning styles - activist and reflector most obviously so, but theorist because of the observational element and pragmatist as the scenario unravels. It externalises what is often the internal parts of the cycle – reflection and abstract conceptualisation – through the debriefing process. I also believed that high fidelity environments offered the greatest return in terms of learning – being rather dismissive of lower fidelity tools. However, through active observation of simulation – both in a setting I am familiar with (mannequin based scenarios) and in one I am not (dental student lab-based simulation) – I am recognising that this view may be only a small aspect of what simulation has to offer and that fidelity is not everything

A one-dimensional model with water-like anomalies and two phase transitions

We investigate a one-dimensional model that shows several properties of water. The model combines the long-range attraction of the van der Waals model with the nearest-neighbor interaction potential by Ben-Naim, which is a step potential that includes a hard core and a potential well. Starting from the analytical expression for the partition function, we determine numerically the Gibbs energy and other thermodynamic quantities. The model shows two phase transitions, which can be interpreted as the liquid-gas transition and a transition between a high-density and a low-density liquid. At zero temperature, the low-density liquid goes into the crystalline phase. Furthermore, we find several anomalies that are considered characteristic for water. We explore a wide range of pressure and temperature values and the dependence of the results on the depth and width of the potential well

The Effects of the Absence of the Natural Father On Interpersonal Problem-Solving of Preschool Children

An Applied Project presented to the faculty of the School of Education at Morehead State University in partial fulfillment of the requirements for the Degree of Education Specialist by Barbara Kennedy Stanley in September of 1983

Emergent spatial goals in an integrative model of the insect central complex

The insect central complex appears to encode and process spatial information through vector manipulation. Here, we draw on recent insights into circuit structure to fuse previous models of sensory-guided navigation, path integration and vector memory. Specifically, we propose that the allocentric encoding of location provided by path integration creates a spatially stable anchor for converging sensory signals that is relevant in multiple behavioural contexts. The allocentric reference frame given by path integration transforms a goal direction into a goal location and we demonstrate through modelling that it can enhance approach of a sensory target in noisy, cluttered environments or with temporally sparse stimuli. We further show the same circuit can improve performance in the more complex navigational task of route following. The model suggests specific functional roles for circuit elements of the central complex that helps explain their high preservation across insect species

A Transect Through the Foreland and Transitional Zone of Western Vermont

Guidebook for field trips in Vermont: New England Intercollegiate Geological Conference, 79th annual meeting, October 16, 17 and 18, 1987: Trips A-

Rivers in practice: clinicians' assessments of patients' decision-making capacity

Since the Rivers v. Katz decision in 1986, clinicians in New York State have been required to assess patient decision-making capacity before judicial review of petitions to administer involuntary medication. The authors examined 42 capacity assessments made by psychiatrists at a large state hospital in New York City. Although the capacity assessments were often incomplete and rarely addressed the treatment decision, most clinicians judged patients as lacking capacity to make treatment decisions. The findings suggest that psychiatrists may view capacity assessments as irrelevant because of the manifestly grave nature of patients' illnesses or may not differentiate the capacity assessment from the mental status examination. The capacity assessment may nonetheless be a useful tool because it encourages clinicians to discuss the proposed treatment with patients and to present information more effectively in court

Loyalty to the profession? A study of Australian financial planners

The purpose of this paper is to examine the demographic variables of age and gender in conjunction with three independent variables: Internal versus external locus of control personality dimension, individualist versus collectivist personality dimension, and perceived environmental uncertainty and to relate same to the professional commitment (PC) of financial planners in Australia. A questionnaire was used to survey a sample of 312 financial planners nationally, with a 36% response rate and statistically significant results. At the 90% confidence level (p=0.10) respondents over the age of 35 demonstrated no difference between their levels of professional commitment than did those under the age of 35, while at the same level of confidence, females demonstrated a statistically significant higher level of PC than did their male counterparts. Respondents with an external locus of control displayed lower levels of PC (p=0.10) that those with an internal locus of control. These findings contribute to our understanding of the professional commitment of financial planners, and are important from a public policy perspective in an era of increasing attention to, and likely increased regulation of, the financial planning industry.<br /

An examination of the organisational commitment of financial planners

This paper sets out to determine whether the demographic variables of age, gender, length of service can be shown to be related to the organisational commitment (OC) of financial planners in Australia. The financial planners were surveyed using an instrument derived from established questionnaires. It was mailed nationally to 312 financial planners. A response rate of 36% was achieved, equating to 113 useable responses. The analyses revealed statistically significant results at the 95% confidence level (p=0.05), that female respondents demonstrated a statistically significant higher level of OC than did their male counterparts.Such findings contribute to our understanding of the organisational commitment of Financial Planners, and have implications for employers in terms of hiring and retention of employees. The analyses are also important from a public policy perspective in an era of increasing attention given to, and likely increased regulation of, the financial planning industry.<br /

Molecular and therapeutic stratification of endometrioid ovarian carcinoma

Epithelial ovarian carcinomas (EOC) comprise five main histological subtypes, each displaying distinct pathological, molecular and clinical characteristics. Endometrioid ovarian carcinomas (EnOC) account for 10% of EOC and have been historically under-investigated. They typically present as early stage, grade 1 or 2 (low grade) tumours arising from endometriosis, and are associated with excellent clinical outcomes. However, Grade 3 (high grade) EnOC, as well as the even rarer de-differentiated carcinomas, can be challenging to differentiate from high grade serous ovarian carcinomas (HGSOC) based on morphology alone. Through the refinement of EnOC diagnostic criteria, several studies have now demonstrated that many previously diagnosed high grade EnOC are in fact HGSOC. This is further supported by gene expression profiling studies demonstrating that a proportion of high grade EnOC cluster together with HGSOC. As such, true high grade EnOC are increasingly rare and are associated with poor prognosis. WT1 immunohistochemistry (IHC) is a useful tool to discriminate high grade EnOC (WT1 negative (WT1-ve)) from HGSOC (WT1 positive), reducing inter-observer variation. To date, clinical and molecular characterisation of EnOC has been confounded by the inclusion of historically misclassified HGSOC in older studies. Mutational analysis performed by more recent studies have either only been applied to low grade EnOC, or lack information on grade or diagnostic criteria used. As a result, the molecular landscape and clinical behaviour of EnOC, in particular high grade EnOC, is not well defined. In this study, tumours historically diagnosed as EnOC were identified through the Edinburgh Ovarian Cancer Database. Contemporary pathology review was performed utilising WT1 and p53 IHC. WT1-ve EnOC of all grades, and WT1-ve tumours with high grade serous and undifferentiated morphology were identified and included in the primary analysis. Clinical characteristics of the primary cohort were extracted from the database. Survival analysis was performed and responses to chemotherapy and endocrine therapy recorded. 63 tumours from the primary cohort underwent DNA extraction and whole exome sequencing (WES); comprising all WT1-ve tumours with mutant p53 expression on immunohistochemistry (p53mut(IHC)) (n=28), all WT1-ve high grade carcinomas with p53 wild-type expression on immunohistochemistry (p53wt (IHC)) (n=12) alongside a randomly selected subset of WT1-ve p53wt (IHC) low grade EnOC tumours (23 of 87 cases, 26.4%). Supervised mutational and copy number analysis was performed across 75 commonly mutated genes previously reported in endometrial, ovarian or pan cancer studies and molecular subgroups were identified. Unsupervised clustering analysis validated these molecular subgroups. Hormone receptor expression levels (oestrogen receptor (ER), progesterone receptor (PR) and androgen receptor (AR)) were evaluated as histoscores in the primary cohort. Multivariable survival analysis, accounting for stage, residual disease, decade of diagnosis. grade and age, was performed on resulting molecular and hormone receptor subgroups. Between May 1980 and December 2013, 125 WT1-ve tumours were identified. Overall five year disease specific survival (DSS) was 73.2% with the most favourable prognosis in those with early stage disease. Five year DSS in patients with advanced stage p53wt (IHC) low grade EnOC was 50.0%. Late relapses beyond five years were common in early stage disease. Patients with stage IV disease had poor prognosis with median DSS of less than one year. Radiological and CA125 response rates to platinum based chemotherapy in evaluable tumours was 44.5% and 69.3%, respectively. Median duration of endocrine therapy in evaluable tumours was 317 days (range 35 – 615 days). Of the 61 tumours successfully sequenced, TP53 mutations (TP53mut) were the most common (45.9%); followed by mutations in EnOC-associated genes (ARID1A (41.0%), CTNNB1 (31.1%), PTEN (24.6%) and PIK3CA (23.0%)). Only TP53mut status was independently associated with shortened DSS (HR=0.35, 95% CI 0.14-0.83, P=0.018). Copy number analysis revealed significantly more alterations in the TP53mut tumours compared to TP53wt tumours (P <0.0001), with a particular enrichment of variation across EnOC-associated genes in the TP53mut subgroup with no EnOC-associated gene mutations. The majority of the primary cohort expressed ER and PR whereas AR expression was low. A PR histoscore of >150, when compared to a PR histoscore ≤ 150, was found to be independently associated with DSS, whereas no associations were observed with ER or AR expression levels. In particular, patients with stage II EnOC and a PR histoscore of >150 displayed a ten year DSS of over 90%. Through this study, TP53 mutation status and a PR histoscore of greater than 150 were identified as independent predictors of survival. This demonstrates EnOC to be a heterogeneous disease with distinct molecular and hormone receptor subgroups that demonstrate differential clinical outcome. Patients with TP53 mutated and/or low PR expression EnOC have inferior prognosis and the development of novel therapeutic agents should be focused on these groups which display the greatest unmet need