Medical student use of communication elements and association with patient satisfaction: a prospective observational pilot study

BACKGROUND: Effective communication with patients impacts clinical outcome and patient satisfaction. We measure the rate at which medical students use six targeted communication elements with patients and association of element use with patient satisfaction. METHODS: Participants included fourth year medical students enrolled in an emergency medicine clerkship. A trained observer measured use of six communication elements: acknowledging the patient by name, introducing themselves by name, identifying their role, explaining the care plan, explaining that multiple providers would see the patient, and providing an estimated duration of time in the emergency department. The observer then conducted a survey of patient satisfaction with the medical student encounter. RESULTS: A total of 246 encounters were documented among forty medical student participants. For the six communication elements evaluated, in 61% of encounters medical students acknowledged the patient, in 91% they introduced themselves, in 58 % they identified their role as a student, in 64% they explained the care plan, in 80% they explained that another provider would see the patient, and in only 6% they provided an estimated duration of care. Only 1 encounter (0.4%) contained all six elements. Patients' likelihood to refer a loved one to that ED was increased when students acknowledged the patient and described that other providers would be involved in patient care (P = 0.016 and 0.015 respectively, Chi Square). Likewise, patients' likelihood to return to the ED was increased when students described their role in patient care (P = 0.035, Chi Square). CONCLUSIONS: This pilot study demonstrates that medical students infrequently use all targeted communication elements. When they did use certain elements, patient satisfaction increased. These data imply potential benefit to additional training for students in patient communication

Green's function for gravitational waves in FRW spacetimes

A method for calculating the retarded Green's function for the gravitational wave equation in Friedmann-Roberson-Walker spacetimes, within the formalism of linearized Einstein gravity is developed. Hadamard's general solution to Cauchy's problem for second-order, linear partial differential equations is applied to the FRW gravitational wave equation. The retarded Green's function may be calculated for any FRW spacetime, with curved or flat spatial sections, for which the functional form of the Ricci scalar curvature $R$ is known. The retarded Green's function for gravitational waves propagating through a cosmological fluid composed of both radiation and dust is calculated analytically for the first time. It is also shown that for all FRW spacetimes in which the Ricci scalar curvatures does not vanish, $R \neq 0$, the Green's function violates Huygens' principle; the Green's function has support inside the light-cone due to the scatter of gravitational waves off the background curvature.Comment: 9 pages, FERMILAB-Pub-93/189-

Ferromagnetic resonators synthesized by metal-organic decomposition epitaxy

Metal-organic decomposition epitaxy is an economical wet-chemical approach suitable to synthesize high-quality low-spin-damping films for resonator and oscillator applications. This work reports the temperature dependence of ferromagnetic resonances and associated structural and magnetic quantities of yttrium iron garnet nanofilms that coincide with single-crystal values. Despite imperfections originating from wet-chemical deposition and spin coating, the quality factor for out-of-plane and in-plane resonances approaches 600 and 1000, respectively, at room temperature and 40 GHz. These values increase with temperature and are 100 times larger than those offered by commercial devices based on complementary metal-oxide semiconductor voltage-controlled oscillators at comparable production costs

The Fine Structure Lines of Hydrogen in HII Regions

The 2s_{1/2} state of hydrogen is metastable and overpopulated in HII regions. In addition, the 2p states may be pumped by ambient Lyman-alpha radiation. Fine structure transitions between these states may be observable in HII regions at 1.1 GHz (2s_{1/2}-2p_{1/2}) and/or 9.9 GHz (2s_{1/2}-2p_{3/2}), although the details of absorption versus emission are determined by the relative populations of the 2s and 2p states. The n=2 level populations are solved with a parameterization that allows for Lyman-alpha pumping of the 2p states. The density of Lyman-alpha photons is set by their creation rate, easily determined from the recombination rate, and their removal rate. Here we suggest that the dominant removal mechanism of Lyman-alpha radiation in HII regions is absorption by dust. This circumvents the need to solve the Lyman-alpha transfer problem, and provides an upper limit to the rate at which the 2p states are populated by Lyman-alpha photons. In virtually all cases of interest, the 2p states are predominantly populated by recombination, rather than Lyman-alpha pumping. We then solve the radiative transfer problem for the fine structure lines in the presence of free-free radiation. In the likely absence of Lyman-alpha pumping, the 2s_{1/2}-2p_{1/2} lines will appear in stimulated emission and the 2s_{1/2}-2p_{3/2} lines in absorption. Searching for the 9.9 GHz lines in high emission measure HII regions offers the best prospects for detection. The lines are predicted to be weak; in the best cases, line-to-continuum ratios of several tenths of a percent might be expected with line strengths of tens to a hundred mK with the Green Bank Telescope.Comment: 18 pages, 2 figures, accepted by ApJ, references added, typos correcte

Ferromagnetic resonances in single-crystal yttrium iron garnet nanofilms fabricated by metal-organic decomposition

Tunable microwave and millimeter wave oscillators and bandpass filters with ultra-low phase noise play a critical role in electronic devices, including wireless communication, microelectronics, and quantum computing. Magnetic materials, such as yttrium iron garnet (YIG), possess ultra-low phase noise and a ferromagnetic resonance tunable up to tens of gigahertz. Here, we report structural and magnetic properties of single-crystal 60 and 130 nm-thick YIG films prepared by metal-organic decomposition epitaxy. These films, consisting of multiple homoepitaxially grown monolayers, are atomically flat and possess magnetic properties similar to those grown with liquid-phase epitaxy, pulsed laser deposition, and sputtering. Our approach does not involve expensive high-vacuum deposition systems and is a true low-cost alternative to current commercial techniques that have the potential to transform the industry

Assessing the performance of maternity care in Europe: A critical exploration of tools and indicators

Background: This paper critically reviews published tools and indicators currently used to measure maternity care performance within Europe, focusing particularly on whether and how current approaches enable systematic appraisal of processes of minimal (or non-) intervention in support of physiological or "normal birth". The work formed part of COST Actions IS0907: "Childbirth Cultures, Concerns, and Consequences: Creating a dynamic EU framework for optimal maternity care" (2011-2014) and IS1405: Building Intrapartum Research Through Health - an interdisciplinary whole system approach to understanding and contextualising physiological labour and birth (BIRTH) (2014-). The Actions included the sharing of country experiences with the aim of promoting salutogenic approaches to maternity care. Methods: A structured literature search was conducted of material published between 2005 and 2013, incorporating research databases, published documents in english in peer-reviewed international journals and indicator databases which measured aspects of health care at a national and pan-national level. Given its emergence from two COST Actions the work, inevitably, focused on Europe, but findings may be relevant to other countries and regions. Results: A total of 388 indicators were identified, as well as seven tools specifically designed for capturing aspects of maternity care. Intrapartum care was the most frequently measured feature, through the application of process and outcome indicators. Postnatal and neonatal care of mother and baby were the least appraised areas. An over-riding focus on the quantification of technical intervention and adverse or undesirable outcomes was identified. Vaginal birth (no instruments) was occasionally cited as an indicator; besides this measurement few of the 388 indicators were found to be assessing non-intervention or "good" or positive outcomes more generally. Conclusions: The tools and indicators identified largely enable measurement of technical interventions and undesirable health (or pathological medical) outcomes. A physiological birth generally necessitates few, or no, interventions, yet most of the indicators presently applied fail to capture (a) this phenomenon, and (b) the relationship between different forms and processes of care, mode of birth and good or positive outcomes. A need was identified for indicators which capture non-intervention, reflecting the reality that most births are low-risk, requiring few, if any, technical medical procedures

A Combination of Independent Transcriptional Regulators Shapes Bacterial Virulence Gene Expression during Infection

Transcriptional regulatory networks are fundamental to how microbes alter gene expression in response to environmental stimuli, thereby playing a critical role in bacterial pathogenesis. However, understanding how bacterial transcriptional regulatory networks function during host-pathogen interaction is limited. Recent studies in group A Streptococcus (GAS) suggested that the transcriptional regulator catabolite control protein A (CcpA) influences many of the same genes as the control of virulence (CovRS) two-component gene regulatory system. To provide new information about the CcpA and CovRS networks, we compared the CcpA and CovR transcriptomes in a serotype M1 GAS strain. The transcript levels of several of the same genes encoding virulence factors and proteins involved in basic metabolic processes were affected in both ΔccpA and ΔcovR isogenic mutant strains. Recombinant CcpA and CovR bound with high-affinity to the promoter regions of several co-regulated genes, including those encoding proteins involved in carbohydrate and amino acid metabolism. Compared to the wild-type parental strain, ΔccpA and ΔcovRΔccpA isogenic mutant strains were significantly less virulent in a mouse myositis model. Inactivation of CcpA and CovR alone and in combination led to significant alterations in the transcript levels of several key GAS virulence factor encoding genes during infection. Importantly, the transcript level alterations in the ΔccpA and ΔcovRΔccpA isogenic mutant strains observed during infection were distinct from those occurring during growth in laboratory medium. These data provide new knowledge regarding the molecular mechanisms by which pathogenic bacteria respond to environmental signals to regulate virulence factor production and basic metabolic processes during infection

The experience of low back pain in people with incomplete spinal cord injury in the USA, UK and Greece

Engineering and Physical Sciences Research Council's (EPSRC

Revisiting the Twentieth Century Through the Lens of Generation X and Digital Games: A Scoping Review

Video games have been around since the 1960s and have impacted upon society in a myriad of different ways. The purpose of this scoping review is to identify existing literature within the domain of video games which recruited participants from the Generation X (1965–1980) cohort. Six databases were searched (ACM, CINHAL Google Scholar, PubMed, Scopus, and Web of Science) focusing on published journal papers between 1970 and 2000. Search results identified 3186 articles guided by the PRISMA Extension for Scoping Reviews (PRISMA-ScR); 4 papers were irretrievable, 138 duplicated papers were removed, leaving 3048 were assessed for eligibility and 3026 were excluded. Articles (n = 22) were included into this review, with four papers primarily published in 1997 and in 1999. Thematic analysis identified five primary themes: purpose and objectives, respective authors’ reporting, technology, ethics and environment) and seven secondary themes: populations, type of participants (e.g. children, students), ethical approval, study design, reimbursement, language, type of assessments. This scoping review is distinctive because it primarily focuses on Generation X, who have experienced and grown-up with videogames, and contributes to several disciplines including: game studies, gerontology and health, and has wider implications from a societal, design and development perspective of video games