Evaluating Medical Student Communication/Professionalism Skills from a Patient’s Perspective

Objective: Evaluate medical students’ communication and professionalism skills from the perspective of the ambulatory patient and later compare these skills in their first year of residency. Methods: Students in third year neurology clerkship clinics see patients alone followed by a revisit with an attending neurologist. The patient is then asked to complete a voluntary, anonymous, Likert scale questionnaire rating the student on friendliness, listening to the patient, respecting the patient, using understandable language, and grooming. For students who had completed 1 year of residency these professionalism ratings were compared with those from their residency director. Results: Seven hundred forty-two questionnaires for 165 clerkship students from 2007 to 2009 were analyzed. Eighty-three percent of forms were returned with an average of 5 per student. In 64% of questionnaires, patients rated students very good in all five categories; in 35% patients selected either very good or good ratings; and <1% rated any student fair. No students were rated poor or very poor. Sixty-two percent of patients wrote complimentary comments about the students. From the Class of 2008, 52% of students received “better than their peers” professionalism ratings from their PGY1 residency directors and only one student was rated “below their peers.” Conclusion: This questionnaire allowed patient perceptions of their students’ communication/professionalism skills to be evaluated in a systematic manner. Residency director ratings of professionalism of the same students at the end of their first year of residency confirms continued professional behavior

Threshold energy surface and Frenkel-pair resistivity for Cu

In-situ electrical resistivity damage-rate measurements in the high voltage electron microscope have been used to study electron-irradiation-induced defect production in copper single crystals at T and surrounded by regions of much higher threshold energy. The corresponding damage function exhibits a plateau of 0.6 Frenkel pairs. the present results imply a Frenkel pair resistivity for C of (2.75/sub -0.2//sup +0.6/) x ..cap omega..-cm

Chapter 3 Wetland Design and Development

The history of efforts to design and develop wetland sites is extensive and rich, especially in the United States. This chapter provides an annotated view of the current state of wetland design and recommends an approach to future efforts using “Hydrogeomorphic Methodology.” Experience over the past century indicates that the most important part of wetland design and development is upfront work to: (1) determine what type of wetland historically occurred in, and is appropriate for a site; (2) understand and attempt to emulate the key ecological processes that created and sustained specific wetland types; (3) compare historical landscapes and wetland attributes with contemporary landscape and site conditions to understand remediating needs; and (4) determine management objectives and capabilities. The foundation for hydrogeomorphic assessments is analysis of historical and current information about geology and geomorphology, soils, topography and elevation, hydrological regimes, plant and animal communities, and physical anthropogenic features. The availability of this information is discussed and the sequence of actions used to prepare hydrogeomorphic matrices of potential historical vegetation communities and maps is provided as in application of information. Specific considerations for designing wetland infrastructure and restoring wetland vegetation are reviewed. An example of a wetland restoration project for the Duck Creek Conservation Area, Missouri is provided to demonstrate use of the hydrogeomorphic approach. We believe that future wetland design and development strategies should include the following actions: (1) wetland conservation must seek to achieve incremental gains at landscape-level scales; (2) the foundation of wetland design is determining the appropriate wetland type for the site being considered; (3) wetland designs should seek to restore and emulate historical form and process as completely as possible and to make systems as self-sustainable as possible; and (4) future design and development of wetlands must anticipate change related to climate, land uses, encroachments, and water availability and rights

Chapter 3 Wetland Design and Development

The history of efforts to design and develop wetland sites is extensive and rich, especially in the United States. This chapter provides an annotated view of the current state of wetland design and recommends an approach to future efforts using “Hydrogeomorphic Methodology.” Experience over the past century indicates that the most important part of wetland design and development is upfront work to: (1) determine what type of wetland historically occurred in, and is appropriate for a site; (2) understand and attempt to emulate the key ecological processes that created and sustained specific wetland types; (3) compare historical landscapes and wetland attributes with contemporary landscape and site conditions to understand remediating needs; and (4) determine management objectives and capabilities. The foundation for hydrogeomorphic assessments is analysis of historical and current information about geology and geomorphology, soils, topography and elevation, hydrological regimes, plant and animal communities, and physical anthropogenic features. The availability of this information is discussed and the sequence of actions used to prepare hydrogeomorphic matrices of potential historical vegetation communities and maps is provided as in application of information. Specific considerations for designing wetland infrastructure and restoring wetland vegetation are reviewed. An example of a wetland restoration project for the Duck Creek Conservation Area, Missouri is provided to demonstrate use of the hydrogeomorphic approach. We believe that future wetland design and development strategies should include the following actions: (1) wetland conservation must seek to achieve incremental gains at landscape-level scales; (2) the foundation of wetland design is determining the appropriate wetland type for the site being considered; (3) wetland designs should seek to restore and emulate historical form and process as completely as possible and to make systems as self-sustainable as possible; and (4) future design and development of wetlands must anticipate change related to climate, land uses, encroachments, and water availability and rights

Bicrystals with strain gradient effects

Boundary between two perfectly bonded single crystals plays an important role in determining the deformation of the bicrystals. This work addresses the role of the grain boundary by considering the elevated hardening of a slip system due to a slip gradient. The slip gradients are associated with geometrically necessary dislocations and their effects become pronounced when a representative length scale of the deformation field is comparable to the dominant microstructural length scale of a material. A new rate-dependent crystal plasticity theory is presented and has been implemented within the finite element method framework. A planar bicrystal under uniform in-plane loading is studied using the new crystal theory. The strain is found to be continuous but nonuniform within a boundary layer around the interface. The lattice rotation is also nonuniform within the boundary layer. The width of the layer is determined by the misorientation of the grains, the hardening of slip systems, and most importantly by the characteristic material length scales. The overall yield strength of the bicrystal is also obtained. A significant grain-size dependence of the yield strength, the Hall- Petch effect is predicted

Nanosecond Time Resolved Electron Diffraction Studies of the (Alpha) to (Beta) Transition in Pure Ti Thin Films using the Dynamic Transmission Electron Microscope (DTEM)

The transient events of the {alpha}-{beta} martensitic transformation in nanocrystalline Ti films were explored via single shot electron diffraction patterns with 1.5 ns temporal resolution. The diffraction patterns were acquired with a newly constructed dynamic transmission electron microscope (DTEM), which combines nanosecond pulsed laser systems and pump-probe techniques with a conventional TEM. With the DTEM, the transient events of fundamental material processes, that are far too fast to be studied by conventional bulk techniques, can be captured in the form of electron diffraction patterns or images with nanosecond temporal resolution. The transient phenomena of the martensitic transformations in nanocrystalline Ti is ideally suited for study in the DTEM, with their rapid nucleation, characteristic interface velocities {approx}1 km/s, and significant irreversible microstructural changes. Free-standing 40-nm-thick Ti films were laser-heated at a rate of {approx}10{sup 10} K/s to a temperature above the 1155 K transition point, then probed at various time intervals with a 1.5-ns-long, intense electron pulse. Diffraction patterns show an almost complete transition to the {beta} phase within 500 ns. Postmortem analysis (after the sample is allowed to cool) shows a reversion to the {alpha} phase coupled with substantial grain growth, lath formation, and texture modification. The cooled material also shows a complete lack of apparent dislocations, suggesting the possible importance of a ''massive'' short-range diffusion transformation mechanism