Integrating Standardized Videos to Supplement the Clinical Physical Examination Curriculum in the First Year of Medical School: An Assessment of Medical Student and OSCE Evaluator Perspective

Background Existing literature indicates medical students benefit from the utilization of multimedia tools to supplement traditional didactic curricula of physical examination technique, as well as the standardization of physical examination instruction.1 2 Although current literature supports the integration of standardized multimedia tools into the didactic curriculum, it lacks a detailed, reproducible integration model for other institutions to follow. Current literature also fails to assess the effect of multimedia tools on student well-being and largely ignores the educator perspective. This study aims to address the above discrepancies by demonstrating a practical approach to integrating supplemental videos into an existing curriculum and assessing first year medical student and OSCE evaluator perspectives at strategic points throughout the process. Methods First-year medical students at the USD SSOM participated in a 7-item Likert scale pre-video integration survey assessing student self-efficacy and competence. Following the video release and OSCE I examination, first-year medical students completed a 15-item Likert scale post-video integration survey assessing student self-efficacy, anxiety reduction, education standardization, and video quality. The OSCE I evaluators completed a 5-item Likert scale survey assessing the role of the video series in education and evaluation standardization. Results Of survey respondents, 63.5% (n = 52) utilized at least one of the videos in the series. Prior to the implementation of the video series, an average of 30.2% of students agreed or strongly agreed with the statement, “I am confident in my ability to demonstrate the skills needed to complete the following exam.” After the implementation of the video series, 100% of video-users agreed or strongly agreed with this statement as compared to 94.2% amongst non-video-users. Amongst video users, 81.8% of students agree or strongly agree that the video series decreased anxiety associated with performing the neurologic, abdomen/thorax, and head and neck exams, compared to 83.8% of students reporting decreased anxiety with the use of the musculoskeletal video series. Of video users, 84.2% of students agree or strongly agree the video resource instructed the students in a similar manner to their peers. Eleven of 16 OSCE evaluators completed the survey, 90.9% of which agree or strongly agree the videos enhanced their understanding of the evaluation expectations. Additionally, 90.9% of OSCE evaluators agree or strongly agree the video series aided in standardization of the evaluation process. Conclusions Overall, this study outlines the successful process of augmenting the traditional didactic curricula of physical examination techniques with a comprehensive, instructional video series, as supported by student and OSCE evaluator response. Video users report decreased anxiety and increased self-efficacy after using the video series. Students and OSCE evaluators found the video series to be useful tool for both educational technique and evaluation standardization

Is analysing the nitrogen use at the plant canopy level a matter of choosing the right optimization criterion?

Optimization theory in combination with canopy modeling is potentially a powerful tool for evaluating the adaptive significance of photosynthesis-related plant traits. Yet its successful application has been hampered by a lack of agreement on the appropriate optimization criterion. Here we review how models based on different types of optimization criteria have been used to analyze traits—particularly N reallocation and leaf area indices—that determine photosynthetic nitrogen-use efficiency at the canopy level. By far the most commonly used approach is static-plant simple optimization (SSO). Static-plant simple optimization makes two assumptions: (1) plant traits are considered to be optimal when they maximize whole-stand daily photosynthesis, ignoring competitive interactions between individuals; (2) it assumes static plants, ignoring canopy dynamics (production and loss of leaves, and the reallocation and uptake of nitrogen) and the respiration of nonphotosynthetic tissue. Recent studies have addressed either the former problem through the application of evolutionary game theory (EGT) or the latter by applying dynamic-plant simple optimization (DSO), and have made considerable progress in our understanding of plant photosynthetic traits. However, we argue that future model studies should focus on combining these two approaches. We also point out that field observations can fit predictions from two models based on very different optimization criteria. In order to enhance our understanding of the adaptive significance of photosynthesis-related plant traits, there is thus an urgent need for experiments that test underlying optimization criteria and competing hypotheses about underlying mechanisms of optimization

The limited importance of size-asymmetric light competition and growth of pioneer species in early secondary forest succession in Vietnam

It is generally believed that asymmetric competition for light plays a predominant role in determining the course of succession by increasing size inequalities between plants. Size-related growth is the product of size-related light capture and light-use efficiency (LUE). We have used a canopy model to calculate light capture and photosynthetic rates of pioneer species in sequential vegetation stages of a young secondary forest stand. Growth of the same saplings was followed in time as succession proceeded. Photosynthetic rate per unit plant mass (Pmass: mol C g−1 day−1), a proxy for plant growth, was calculated as the product of light capture efficiency [Φmass: mol photosynthetic photon flux density (PPFD) g−1 day−1] and LUE (mol C mol PPFD−1). Species showed different morphologies and photosynthetic characteristics, but their light-capturing and light-use efficiencies, and thus Pmass, did not differ much. This was also observed in the field: plant growth was not size-asymmetric. The size hierarchy that was present from the very early beginning of succession remained for at least the first 5 years. We conclude, therefore, that in slow-growing regenerating vegetation stands, the importance of asymmetric competition for light and growth can be much less than is often assumed

Are wildcard events on infrastructure systems opportunities for transformational change?

Infrastructure systems face a number of pressing challenges relating to demographics, environment, finance and governance pressures. Furthermore, infrastructure mediates the way in which everyday lives are conducted; their form and function creating a persistence of unsustainable practice and behaviour that cannot be changed even if change is desired. There is a need to find means by which this obduracy can be broken so that new, more sustainable futures can be planned. This paper develops a methodology, taking concepts from both engineering and social science. Wild cards, or physical disruptions, are used to ‘destructively test’ complex infrastructure systems and the multi-level perspective is used as a framework for analysing the resulting data. This methodology was used to examine a number of case studies, and with focus groups consisting of a range of different infrastructure providers and managers, to gain a better understanding of systems’ sociotechnical characteristics and behaviours. A number of impactful ‘intervention points’ emerged that offered the opportunity to promote radical changes towards configurations of infrastructure systems that provide for ‘less’ physical infrastructure. This paper also examines the utility of wild cards as enablers of transition to these ‘less’ configurations and demonstrates how a ‘wild card scenario’ can be used to co-design infrastructure adaptation from with both infrastructure providers and users

Global leaf trait estimates biased due to plasticity in the shade

The study of leaf functional trait relationships, the so-called leaf economics spectrum1,2, is based on the assumption of high-light conditions (as experienced by sunlit leaves). Owing to the exponential decrease of light availability through canopies, however, the vast majority of the world's vegetation exists in at least partial shade. Plant functional traits vary in direct dependence of light availability3, with different traits varying to different degrees, sometimes in conflict with expectations from the economic spectrum3. This means that the derived trait relationships of the global leaf economic spectrum are probably dependent on the extent to which observed data in existing large-scale plant databases represent high-light conditions. Here, using an extensive worldwide database of within-canopy gradients of key physiological, structural and chemical traits3, along with three different global trait databases4,5, we show that: (1) accounting for light-driven trait plasticity can reveal novel trait relationships, particularly for highly plastic traits (for example, the relationship between net assimilation rate per area (Aa) and leaf mass per area (LMA)); and (2) a large proportion of leaf traits in current global plant databases reported as measured in full sun were probably measured in the shade. The results show that even though the majority of leaves exist in the shade, along with a large proportion of observations, our current understanding is too focused on conditions in the sun

Is America coming apart? Socioeconomic segregation in neighborhoods, schools, workplaces, and social networks, 1970–2020

As income inequality in the United States has reached an all-time high, commentators from across the political spectrum warn about the social implications of these economic changes. America, they fear, is “coming apart” as the gap between the rich and poor grows into a fault line. This paper provides a comprehensive review of empirical scholarship in sociology, education, demography, and economics in order to address the question: How have five decades of growing economic inequality shaped America's social landscape? We find that growing levels of income inequality have been accompanied by increasing socioeconomic segregation across (1) friendship networks and romantic partners, (2) residential neighborhoods, (3) K-12 and university education, and (4) workplaces and the labor market. The trends documented in this review give substance to commentators' concerns: compared to the 1970s, rich and poor Americans today are less likely to know one another and to share the same social spaces. The United States is a nation divided.Published versio

Tallo: A global tree allometry and crown architecture database.

This is the final version. Available from Wiley via the DOI in this record. Data capturing multiple axes of tree size and shape, such as a tree's stem diameter, height and crown size, underpin a wide range of ecological research-from developing and testing theory on forest structure and dynamics, to estimating forest carbon stocks and their uncertainties, and integrating remote sensing imagery into forest monitoring programmes. However, these data can be surprisingly hard to come by, particularly for certain regions of the world and for specific taxonomic groups, posing a real barrier to progress in these fields. To overcome this challenge, we developed the Tallo database, a collection of 498,838 georeferenced and taxonomically standardized records of individual trees for which stem diameter, height and/or crown radius have been measured. These data were collected at 61,856 globally distributed sites, spanning all major forested and non-forested biomes. The majority of trees in the database are identified to species (88%), and collectively Tallo includes data for 5163 species distributed across 1453 genera and 187 plant families. The database is publicly archived under a CC-BY 4.0 licence and can be access from: https://doi.org/10.5281/zenodo.6637599. To demonstrate its value, here we present three case studies that highlight how the Tallo database can be used to address a range of theoretical and applied questions in ecology-from testing the predictions of metabolic scaling theory, to exploring the limits of tree allometric plasticity along environmental gradients and modelling global variation in maximum attainable tree height. In doing so, we provide a key resource for field ecologists, remote sensing researchers and the modelling community working together to better understand the role that trees play in regulating the terrestrial carbon cycle.Natural Environment Research Council (NERC)Natural Environment Research Council (NERC); Ministry of Education, Youth and Sports of the Czech RepublicFAPEMIGUniversidad Nacional Autónoma de MéxicoUniversidad Nacional Autónoma de MéxicoConsejo Nacional de Ciencia y TecnologíaSwedish Energy AgencyUKRIFederal Ministry of Education and ResearchNational Natural Science Foundation of ChinaNational Natural Science Foundation of ChinaNational Science FoundationNational Science FoundationInternational Foundation for ScienceP3FACDynAfForNanjing Forestry UniversityJiangsu Science and Technology Special ProjectHebei UniversityAgence Nationale de la RechercheAgence Nationale de la RechercheAgua Salud ProjectU.S. Department of EnergyCAPE