Teaching Medical Students Optimal Consulting Skills: The Challenge of Generating Better Referring Physicians.

Rationale and objectives We sought to incorporate a new teaching module into the traditional medical student radiology clerkship, to improve the necessary skills for future referring physicians. Materials and methods A new required and graded module was introduced in 2014 into the radiology clerkship in year three of medical school: the Mystery Case. Each student was provided a unique and undifferentiated case from a dedicated teaching file containing de-identified images and requisition data. Students were expected to complete three serial tasks over one week: 1) prepare a voice recognition-derived, structured radiological report utilizing appropriate and relevant vocabulary; 2) discuss pertinent additional clinical information; and 3) discuss appropriate follow-up imaging, in addition to information on how to best prepare patients for these potential patient exams (e.g., with or without contrast, bowel preparation, and length of study). Students were provided written examples and dedicated class instruction with interactive discussions covering specific cases and associated related cases through random pairing with radiology resident and attending mentors. At the close of the week, students gave brief oral presentations of their cases and submitted the tasks for a written evaluation. Upon completion of the clerkship, the students completed a Likert-type six-item survey to evaluate the perceived improvement in select skills. Results The survey was completed by 82% (54/66) of the enrolled students, with 85% finding the Mystery Case an effective use of time. Medical students perceived an improved awareness of the patient care process (77%), awareness of the medical imaging resources available (89%), ability to understand a radiology report (74%), and ability to advise patients (69%). Conclusion Introduction of the Mystery Case as a graded exercise in the medical school radiology clerkship was perceived by students as effective use of time, with an improvement in the skills essential for future referring physicians

(Invited) Band Line-up of High-k Oxides on GaN

We present comprehensive experimental work on TixAl1-xOy (with x = 9%, 16%, 25%, 36%, 100%) and GaxAl1-xOy (x = 5%, 20%, 80% and 95%) fabricated using atomic layer deposition with the aim of achieving favorable band alignment with GaN for device applications. The permittivity, k, has been found to be enhanced from ~10 for 9% Ti to 76 for TiO2, but brings unfavorable band line-up and a small conduction band offset (&lt; 0.1 eV) with GaN for all Ti% studied. On the other hand, GaxAl1-xOy (x = 5%, 20%) films show substantial increase of the band gap from 4.5 eV for Ga2O3 to 5.5 eV for x = 5% Ga and 6.0 eV for x = 20% Ga in mixed oxides and a strong suppression of leakage current in associated metal insulator semiconductor (MIS) capacitors.</jats:p

Bilayer manganites: polarons in the midst of a metallic breakdown

The exact nature of the low temperature electronic phase of the manganite materials family, and hence the origin of their colossal magnetoresistant (CMR) effect, is still under heavy debate. By combining new photoemission and tunneling data, we show that in La{2-2x}Sr{1+2x}Mn2O7 the polaronic degrees of freedom win out across the CMR region of the phase diagram. This means that the generic ground state is that of a system in which strong electron-lattice interactions result in vanishing coherent quasi-particle spectral weight at the Fermi level for all locations in k-space. The incoherence of the charge carriers offers a unifying explanation for the anomalous charge-carrier dynamics seen in transport, optics and electron spectroscopic data. The stacking number N is the key factor for true metallic behavior, as an intergrowth-driven breakdown of the polaronic domination to give a metal possessing a traditional Fermi surface is seen in the bilayer system.Comment: 7 pages, 2 figures, includes supplementary informatio

Fourier transform ion cyclotron resonance mass spectrometric detection of small Ca2+-induced conformational changes in the regulatory domain of human cardiac troponin C

AbstractTroponin C (TnC), a calcium-binding protein of the thin filament of muscle, plays a regulatory role in skeletal and cardiac muscle contraction. NMR reveals a small conformational change in the cardiac regulatory N-terminal domain of TnC (cNTnC) on binding of Ca2+ such that the total exposed hydrophobic surface area increases very slightly from 3090 ± 86 Å2 for apo-cNTnC to 3108 ± 71 Å2 for Ca2+-cNTnC. Here, we show that measurement of solvent accessibility for backbone amide protons by means of solution-phase hydrogen/deuterium (H/D) exchange followed by pepsin digestion, high-performance liquid chromatography, and electrospray ionization high-field (9.4 T) Fourier transform Ion cyclotron resonance mass spectrometry is sufficiently sensitive to detect such small ligand binding-induced conformational changes of that protein. The extent of deuterium incorporation increases significantly on binding of Ca2+ for each of four proteolytic segments derived from pepsin digestion of the apo- and Ca2+-saturated forms of cNTnC. The present results demonstrate that H/D exchange monitored by mass spectrometry can be sufficiently sensitive to detect and identify even very small conformational changes in proteins, and should therefore be especially informative for proteins too large (or too insoluble or otherwise intractable) for NMR analysis

Language and anxiety: an ethnographic study of international postgraduate students

This paper presents some findings from an ethnographic study of international postgraduate students at a university in the South of England, which involved interviews and participant observation over a twelve-month academic year. One of the major themes that emerged from this research was students’ anxiety over their level of English language. Although all students entered their course with a minimum level of IELTS 6, the majority felt disadvantaged by particularly poor spoken English, and suffered feelings of anxiety, shame and inferiority. Low self-confidence meant that they felt ill-equipped to engage in class discussion and in social interaction which used English as the medium of communication. A common reaction to stress caused by language problems was to retreat into monoethnic communication with students from the same country, further inhibiting progress in language. Whilst some linguistic progress was made by nearly all students during the academic sojourn, the anxiety suffered by students in the initial stage must not be underestimated, and appropriate support systems must be put in place to alleviate their distress

Search for a Scalar Bottom Quark with Mass 3.5-4.5 GeV/c2c^{2}

We report on a search for a supersymmetric $\tilde{B}$ meson with mass between 3.5 and 4.5 GeV/$c^2$ using 4.52 ${\rm fb}^{-1}$ of integrated luminosity produced at $\sqrt{s}=10.52$ GeV, just below the $e^+e^-\to B\bar{B}$ threshold, and collected with the CLEO detector. We find no evidence for a light scalar bottom quark.Comment: 10 pages postscript, also available through http://w4.lns.cornell.edu/public/CLN

Determination of total and available fractions of PAHs by SPME in oily wastewaters : overcoming interference from NAPL and NOM

Background, aim, and scope Polycyclic aromatic hydrocarbons (PAHs) are often found in oily wastewaters. Their presence is usually the result of human activities and has a negative effect on the environment. One important step in addressing this problem is to evaluate the effectiveness of PAH removal by biological processes since these are the most cost-effective treatments known today. Many techniques are presently available for PAH determination in wastewaters. Solid phase microextracion (SPME) is known to be one of the most effective techniques for this purpose. When analyzing complex matrices with substances such as natural organic matter (NOM) and non-aqueous phase liquids (NAPL), it is important to differentiate the free dissolved PAH from matrix-bonded PAH. PAHs associated with the bonded fraction are less susceptible to biological treatment. The present study concerns the development of a simple and suitable methodology for the determination of the freely dissolved and the total fraction of PAHs present in oily wastewaters. The methodology was then applied to an oily wastewater from a fuel station retention basin. Material and methods Headspace SPME was used for analyzing PAH since the presence of a complex or dirty matrix in direct contact with the fiber may damage it. Four model PAHs—anthracene, fluorene, phenanthrene, and pyrene—were analyzed by GC-MS. Negligible depletion SPME technique was used to determine the free fraction. Total PAH was determined by enhancing the mass transfer from the bonded phase to the freely dissolved phase by temperature optimization and the use of the method of standard additions. The PAH absorption kinetics were determined in order to define the optimal sampling conditions for this method. The fitting of the experimental data to a mathematical model was accomplished using Berkeley Madonna software. Humic acid and silicon oil were used as model NOM and NAPL, respectively, to study the effect of these compounds on the decrease of SPME response. Then, the method was evaluated with wastewater from a fuel station spill retention basin. Results The SPME kinetic parameters—k 1 (uptake rate), k 2 (desorption rate), and K SPME (partition coefficient)—were determined from experimental data modeling. The determination of the free fraction required 15-min sampling to ensure that PAH depletion from sample was below 1%. For total PAH, a 30-min extraction at 100°C ensured the maximum signal response in the GC-MS. For the determination of free and total PAHs, extractions were performed before reaching the SPME equilibrium. The wastewater used in this study had no free fraction of the analyzed PAHs. However, the four studied PAHs were found when the method for total PAH was used. Discussion The addition of NOM and NAPL dramatically decreased the efficiency of the SPME. This decrease was the result of a greater partition of the PAHs to the NAPL and NOM phases. This fact was also observed in the analysis of the fuel station spill retention basin, where no free PAH was measured. However, using the method of standard addition for the determination of total PAH, it was possible to quantify all four PAHs. Conclusions The method developed in the present study was found to be adequate to differentiate between free and total PAH present in oily wastewater. It was determined that the presence of NOM and NAPL had a negative effect on SPME efficiency. Recommendations and perspectives The presence of binding substances had a great influence on SPME kinetics. Therefore, it is of extreme importance to determine their degree of interference when analyzing oily wastewaters or results can otherwise be erroneous. Other factors influencing the total PAH determinations should be considered in further studies.Fundação para a Ciência e a Tecnologia (FCT) - SFRH/BD/ 18816/2004, POCI/AMB/61044/200