A method to quantify residents\u27 jargon use during counseling of standardized patients about cancer screening

Background Jargon is a barrier to effective patient-physician communication, especially when health literacy is low or the topic is complicated. Jargon is addressed by medical schools and residency programs, but reducing jargon usage by the many physicians already in practice may require the population-scale methods used in Quality Improvement. Objective To assess the amount of jargon used and explained during discussions about prostate or breast cancer screening. Effective communication is recommended before screening for prostate or breast cancer because of the large number of false-positive results and the possible complications from evaluation or treatment. Participants Primary care internal medicine residents. Measurements Transcripts of 86 conversations between residents and standardized patients were abstracted using an explicit-criteria data dictionary. Time lag from jargon words to explanations was measured using “statements,” each of which contains one subject and one predicate. Results Duplicate abstraction revealed reliability κ = 0.92. The average number of unique jargon words per transcript was 19.6 (SD = 6.1); the total jargon count was 53.6 (SD = 27.2). There was an average of 4.5 jargon-explanations per transcript (SD = 2.3). The ratio of explained to total jargon was 0.15. When jargon was explained, the average time lag from the first usage to the explanation was 8.4 statements (SD = 13.4). Conclusions The large number of jargon words and low number of explanations suggest that many patients may not understand counseling about cancer screening tests. Educational programs and faculty development courses should continue to discourage jargon usage. The methods presented here may be useful for feedback and quality improvement efforts

Pediatric residents\u27 use of jargon during counseling about newborn genetic screening results

OBJECTIVE. The goal was to investigate pediatric residents’ usage of jargon during discussions about positive newborn screening test results. METHODS. An explicit-criteria abstraction procedure was used to identify jargon usage and explanations in transcripts of encounters between residents and standardized parents of a fictitious infant found to carry cystic fibrosis or sickle cell hemoglobinopathy. Residents were recruited from a series of educational workshops on how to inform parents about positive newborn screening test results. The time lag from jargon words to explanations was measured by using “statements,” each of which contained 1 subject and 1 predicate. RESULTS. Duplicate abstraction revealed reliability K of 0.92. The average number of unique jargon words per transcript was 20; the total jargon count was 72.3 words. There was an average of 7.5 jargon explanations per transcript, but the explained/ total jargon ratio was only 0.17. When jargon was explained, the average time lag from the first usage to the explanation was 8.2 statements. CONCLUSION. The large number of jargon words and the small number of explanations suggest that physicians’ counseling about newborn screening may be too complex for some parents

Child Health Providers\u27 Precautionary Discussion of Emotions During Communication about Results of Newborn Genetic Screening

Objective To demonstrate a quantitative abstraction method for Communication Quality Assurance projects to assess physicians\u27 communication about hidden emotions after newborn genetic screening. Design Communication quality indicator analysis. Setting Standardized parent encounters performed in practicing physicians\u27 clinics or during educational workshops for residents. Participants Fifty-nine pediatrics residents, 53 pediatricians, and 31 family physicians. Intervention Participants were asked to counsel standardized parents about a screening result; counseling was recorded, transcribed, and parsed into statements (each with 1 subject and 1 predicate). Pairs of abstractors independently compared statements with a data dictionary containing explicit-criteria definitions. Outcome Measures Four groups of precautionary empathy behaviors (assessment of emotion, anticipation/validation of emotion, instruction about emotion, and caution about future emotion), with definitions developed for both definite and partial instances. Results Only 38 of 143 transcripts (26.6%) met definite criteria for at least 1 of the precautionary empathy behaviors. When partial criteria were counted, this number increased to 80 of 143 transcripts (55.9%). The most common type of precautionary empathy was the instruction about emotion behavior (eg, don\u27t be worried ), which may sometimes be leading or premature. Conclusions Precautionary empathy behaviors were rare in this analysis. Further study is needed, but this study should raise concerns about the quality of communication services after newborn screening

Migration, human capital, and climate change

This thesis investigates the relationships between climate change, human capital accumulation, global inequality, and migration at various spatial scales. The first chapter analyzes the factors influencing the geographic distribution of high-skilled human capital and their implications for inequality. A theoretical world economy model is developed that produces projections of population, migration, urbanization, and income for the 21st century. The second chapter extends this model and includes channels through which temperature and sea-level rise affect productivity and individual mobility. The robustness of socio-demographic projections to several different climate change scenarios is assessed. The third chapter studies the specific links between climate change and human capital formation. A theoretical model is developed and empirical evidence from Africa is provided illustrating these links. Finally, the fourth chapter revisits the implications of international migration for human capital accumulation and inequality. A new dyadic approach is proposed that establishes the micro-foundations of the relationship between higher education and migration decisions. The findings of the thesis emphasize the importance of policies that improve access to all levels of education, enhance education quality, encourage climate change adaptation, and contribute to sustainable urban development.(ECGE - Sciences économiques et de gestion) -- UCL, 201

Sunset Provisions in the Local Tax Code: Best Practices

The primary objective of this research project is to identify the main uses of the sunset provision as it relates to the local tax code. This research project utilizes a case study approach to collect and analyze sunset tax legislation from five municipalities. Capital project funding is found to be the primary use of taxes with a sunset provision. Other uses associated with sunset taxation include transportation infrastructure, capital funding, bond financing, and public safety. Through the analysis process for this research project, five best practices were developed to guide municipalities who engage in sunset taxation with respect to their local taxing authority: 1) sunsetting taxes are not short-term solutions to long-term needs, 2) expressly identify and define the purpose of the sunset tax revenues, 3) align the source of sunsetting tax revenue with those who benefit, 4) establish a citizen committee to hold the government accountable for its use of sunset tax(es); and 5) ensure transparency is maintained throughout the life of the sunset tax(es)

Selected-fit versus induced-fit protein binding: Kinetic differences and mutational analysis

The binding of a ligand molecule to a protein is often accompanied by conformational changes of the protein. A central question is whether the ligand induces the conformational change (induced-fit), or rather selects and stabilizes a complementary conformation from a pre-existing equilibrium of ground and excited states of the protein (selected-fit). We consider here the binding kinetics in a simple four-state model of ligand-protein binding. In this model, the protein has two conformations, which can both bind the ligand. The first conformation is the ground state of the protein when the ligand is off, and the second conformation is the ground state when the ligand is bound. The induced-fit mechanism corresponds to ligand binding in the unbound ground state, and the selected-fit mechanism to ligand binding in the excited state. We find a simple, characteristic difference between the on- and off-rates in the two mechanisms if the conformational relaxation into the ground states is fast. In the case of selected-fit binding, the on-rate depends on the conformational equilibrium constant, while the off-rate is independent. In the case of induced-fit binding, in contrast, the off-rate depends on the conformational equilibrium, while the on-rate is independent. Whether a protein binds a ligand via selected-fit or induced-fit thus may be revealed by mutations far from the protein's binding pocket, or other "perturbations" that only affect the conformational equilibrium. In the case of selected-fit, such mutations will only change the on-rate, and in the case of induced-fit, only the off-rate.Comment: 6 pages, 3 figures; to appear in "Proteins: Structure, Function, and Bioinformatics

Climate Change, Inequality, and Human Migration

This paper investigates the long-term implications of climate change on local, interregional, and international migration of workers. For nearly all of the world's countries, our micro-founded model jointly endogenizes the effects of changing temperature and sea level on income distribution and individual decisions about fertility, education, and mobility. Climate change intensifies poverty and income inequality creating favorable conditions for urbanization and migration from low-to high-latitude countries. Encompassing slow-and fast-onset mechanisms, our projections suggest that climate change will induce the voluntary and forced displacement of 100 to 160 million workers (200 to 300 million climate migrants of all ages) over the course of the 21st century. However, under current migration laws and policies, forcibly displaced people predominantly relocate within their country and merely 20% of climate migrants opt for long-haul migration to OECD countries. If climate change induces generalized and persistent conflicts over resources in regions at risk, we project significantly larger cross-border flows in the future

Efficacy of imidacloprid 10%/moxidectin 1% spot-on formulation (Advocate®) in the prevention and treatment of feline aelurostrongylosis

Background: In three randomized, controlled laboratory efficacy studies, the efficacy in the prevention of patent infections of a topical combination of imidacloprid 10%/moxidectin 1% (Advocate® spot-on formulation for cats, Bayer Animal Health GmbH) against larval stages and immature adults of Aelurostrongylus abstrusus, as well as the treatment efficacy of a single or three monthly treatments against adult A. abstrusus, were evaluated. Methods: Cats were experimentally inoculated with 300–800 third-stage larvae (L3). Each group comprised 8 animals and the treatment dose was 10 mg/kg bodyweight (bw) imidacloprid and 1 mg/kg bw moxidectin in each study. Prevention of the establishment of patent infections was evaluated by two treatments at a monthly interval at three different time points before and after challenge infection. Curative efficacy was tested by one or three treatments after the onset of patency. Worm counts at necropsy were used for efficacy calculations. Results: In Study 1, the control group had a geometric mean (GM) of 28.8 adult nematodes and the single treatment group had a GM of 3.4 (efficacy 88.3%). In Study 2, the control group had a GM of 14.3, the prevention group had a GM of 0 (efficacy 100%), while the treatment group had a GM of 0.1 (efficacy 99.4%). In Study 3, the GM worm burden in the control group was 32.6 compared to 0 in all three prevention groups (efficacy 100% for all of those groups). Conclusions: The monthly administration of Advocate® reliably eliminated early larval stages and thereby prevented lung damage from and patent infections with A. abstrusus in cats. Regarding treatment, a single application of Advocate® reduced the worm burden, but it did not sufficiently clear the infection. In contrast, three monthly treatments were safe and highly efficacious against A. abstrusus

AN ORTHOPEDIC EXAM FOR ATHLETIC INJURY RISK FACTORS

Athletic injuries, in particular stress fractures, are common among U.S. Navy SEAL trainees during their extensive program of upper and lower body physical training. Between 1980 and 1986 there were over 200 stress fractures, accounting for almost halfof all medical dropouts from the program. Most of the injuries are overuse related, and potentially preventable. In an attempt to identify physical risk factors that could be used in a pre-selection process, a simple reproducible physical exam emphasizing biomechanical factors was devised and used to evaluate men about to begin training