Gaming: Occupation-Based NBCOT Exam Preparation

The purpose of this scholarly project was to create a novel, unique, and effective preparation tool for the National Board for Certification in Occupational Therapy (NBCOT) certification examination. A literature review of 40 evidence-based journal articles addressed adult learning principles; guidelines for facilitating learning; types of, advantages, and disadvantages of using gaming in higher education; and preparation methods for high-stakes examinations. Information reviewed also included current preparation tools; exam blueprint; and domain, task, and knowledge statements ofthe NBCOT certification examination. An Open Book: NBCOT Exam Prep Game is a board game that can be used as a supplementary preparation tool for candidates who are preparing for the NBCOT certification examination. A board game was chosen for its ability to reduce anxiety, increase motivation to study, allow test takers to learn perspectives from one another, and increase confidence for taking an exam. An Open Book: NBCOT Exam Prep Game is designed to use group discussion, simulated exercise, problem-solving activities, case methods, and peer-helping activities to stimulate learning and provide the opportunity to apply knowledge required for passing the certification exam. Adult learning principles and concepts from the Occupational Adaptation model provide the foundation for the project design. The design of the game board and questions were developed with the blueprint of the NBCOT examination and the validated domain, task, and knowledge statements as foundational information. Evidence in the literature supports the use of games in higher education to reduce anxiety, increase motivation to study, allow test takers to learn perspectives from one another, and increase confidence for taking an exam. The product of this scholarly project presents a social learning tool in the form of a board game that incorporates adult learning principles, concepts of the Occupational Adaptation model, and the NBCOT blueprint and domain, task, and knowledge statements reflecting current practice in occupational therapy. An Open Book: NBCOT Exam Prep Game is designed to supplement current preparation tools

Electronic risk assessment for venous thromboembolism: investigating physicians' rationale for bypassing clinical decision support recommendations.

Objective: The underutilisation of venous thromboembolism (VTE) prophylaxis is still a problem in the UK despite the emergence of national guidelines and incentives to increase the number of patients undergoing VTE risk assessments. Our objective was to examine the reasons doctors gave for not prescribing enoxaparin when recommended by an electronic VTE risk assessment alert. Design: We used a qualitative research design to conduct a thematic analysis of free text entered into an electronic prescribing system. Setting: The study took place in a large University teaching hospital, which has a locally developed electronic prescribing system known as PICS (Prescribing, Information and Communication System). Participants: We extracted prescription data from all inpatient admissions over a 7-month period in 2012 using the audit database of PICS. Intervention: The completion of the VTE risk assessment form introduced into the hospital-wide electronic prescribing and health records system is mandatory. Where doctors do not prescribe VTE prophylaxis when recommended, they are asked to provide a reason for this decision. The free-text field was introduced in May 2012. Primary and Secondary Outcome Measures: Free-text reasons for not prescribing enoxaparin when recommended were thematically coded. Results: A total of 1136 free-text responses from 259 doctors were collected in the time period and 1206 separate reasons were analysed and coded. 389 reasons (32.3%) for not prescribing enoxaparin were coded as being due to 'clinical judgment'; in 288 (23.9%) of the responses, doctors were going to reassess the patient or prescribe enoxaparin; and in 245 responses (20.3%), the system was seen to have produced an inappropriate alert. Conclusions: In order to increase specificity of warnings and avoid users developing alert fatigue, it is essential that an evaluation of user responses and/or end user feedback as to the appropriateness and timing of alerts is obtained

Ex-vivo perfusion bioassay : an excellent technique to measure the bioactivity of inhalable insulin coated microcrystals

Purpose: To measure the bioactivity of inhalable insulin coated microcrystals using a perfusion bioassay that measures its vasodilatory effect on smooth muscle arterial tissue. Methods: The bioactivity of an insulin protein coated microcrystal (PCMC), a potential candidate for pulmonary drug delivery and commercial insulin was determined on a Danish Myo Tech P110 pressure myograph system. 12 week old Mesenteric resistance arteries from Male Wistar rats were isolated and immersed in a physiological salt solution (PSS) and attached to 2 opposing hollow glass micro-cannula (outer diameter 80 microns). The PSS was gradually warmed to 37°C (at a pressure less than 5mm Hg) for 1hr. Subsequently the pressure was increased up to 40mm Hg over a period 15 minutes and equilibrated for a further 15 minutes after gassing with 95%O2 / 5%CO2 to achieve a pH of 7.4 at 37°C. After normalisation by two washes of 123mM KCl and exposure to 1-10mM noradrenaline the arteries were exposed intraluminally to each insulin preparation by gradual infusion directly into the lumen via a fetal microcannulae inserted to the tip of the glass mounting cannula, at a constant pressure. Results: The preliminary results (full cummulative response curve yet to be determined) demonstrate insulin mediated relaxation to noradrenaline preconstriction. The level of constriction drops from 100% to 42% as the concentration of insulin increases from -11 to -9 Log M for the PCMC compared with a drop from 100 % to 65% for the commercial insulin preparation. However the more potent vasodilatory effect found for the insulin PCMC is more likely to be a result of variance introduced in each dilution step than a real increase in potency. Conclusion: The perfusion bioassay technique provides an excellent method of measuring insulin bioactivity and indicates the insulin loaded on the microcrystal support is fully active

Trust in Private and Common Property Experiments

We report the results from a series of experiments designed to investigate behavior in two settings that are frequently posited in the policy literature as generating different outcomes: private property and common property. The experimental settings closely parallel earlier experimental studies of the investment or trust game. The primary research question relates to the effect of the initial allocation of property rights on the level of trust that subjects will extend to others with whom they are linked. We find that assigning the initial endowments as common property of each of N pairs of a first mover and second mover leads to marginally greater cooperation or trust than when the initial endowments are fully owned by the two individual movers as their, respective, private property. Subjectsâ?? decisions are also shown to be correlated with attitudes toward trust and fairness that are measured in post-experiment questionnaires.

A toolkit to support the implementation of electronic prescribing systems into UK hospitals: preliminary recommendations.

Hospital electronic prescribing (or ePrescribing) systems have the potential to reduce drug-related morbidity and mortality. However, their implementation and adoption has been slow to date, despite the considerable service interest in implementing systems and the long-standing policy drive towards computerization. The underlying reasons may include the demise of the National Programme for Information Technology; a lack of change management expertise and capacity in the National Health Service (NHS); the relatively immature and fragmented market; limited standards guiding procurement, functional specifications and expected benefits; and lack of resources

Trust in Private and Common Property Experiments

We report the results from a series of experiments designed to investigate behavior in two settings that are frequently posited in the policy literature as generating different outcomes: private property and common property. The experimental settings closely parallel earlier experimental studies of the investment or trust game. The primary research question relates to the effect of the initial allocation of property rights on the level of trust that subjects will extend to others with whom they are linked. We find that assigning the initial endowments as common property of each of N pairs of a first mover and second mover leads to marginally greater cooperation or trust than when the initial endowments are fully owned by the two individual movers as their, respective, private property. Subjects’ decisions are also shown to be correlated with attitudes toward trust and fairness that are measured in post-experiment questionnaires

Pharmacist-Physician Communications in a Highly Computerised Hospital:Sign-Off and Action of Electronic Review Messages

<div><p>Background</p><p>Some hospital Computerized Physician Order Entry (CPOE) systems support interprofessional communication. The aim of this study was to investigate the effectiveness of pharmacist-physician messages sent via a CPOE system.</p><p>Method</p><p>Data from the year 2012 were captured from a large university teaching hospital CPOE database on: 1) review messages assigned by pharmacists; 2) details of the prescription on which the messages were assigned; and 3) details of any changes made to the prescription following a review message being assigned. Data were coded for temporal, message and prescription factors. Messages were analysed to investigate: 1) whether they were signed-off; and 2) the time taken. Messages that requested a measurable action were further analysed to investigate: 1) whether they were actioned as requested; and 2) the time taken. We conducted a multivariable analysis using Generalised Estimating Equations (GEE) to account for the effects of multiple factors simultaneously, and to adjust for any potential correlation between outcomes for repeated review messages on the same prescription. All analyses were performed using SPSS 22 (IBM SPSS Inc., Chicago, IL, USA), with p<0.05 considered significant.</p><p>Results</p><p>Pharmacists assigned 36,245 review messages to prescriptions over the 12 months, 34,506 of which were coded for analysis after exclusions. Nearly half of messages (46.6%) were signed-off and 65.5% of these were signed-off in ≤ 48 hours. Of the 9,991 further analysed for action, 35.8% led to an action as requested by the pharmacist and just over half of these (57.0%) were actioned in ≤ 24 hours. Factors predictive of an action were the time since the prescription was generated (p<0.001), pharmacist grade (p<0.001), presence of a high-risk medicine (p<0.001), messages relating to reconciliation (p = 0.004), theme of communication (p<0.001), speciality, (p<0.001), category of medicine (p<0.001), and regularity of the prescription (p<0.001).</p><p>Conclusion</p><p>In this study we observed a lower rate of sign-off and action than we might have expected, suggesting uni-directional communication via the CPOE system may not be optimal. An established pharmacist-physician collaborative working relationship is likely to influence the prioritisation and response to messages, since a more desirable outcome was observed in settings and with grades of pharmacists where this was more likely. Designing systems that can facilitate collaborative communication may be more effective in practice.</p></div

Exploration of the Windward Passage and Jamaica Channel: Tectonic Gateways to the Caribbean Sea

The Ocean Exploration Trust (OET) Workshop on Telepresence-Enabled Exploration of the Caribbean Region was convened in November 2012 to plan for the 2013 field season with the idea that Exploration Vessel (E/V) Nautilus and its Corps of Exploration would spend only one year working in the Gulf of Mexico and the Caribbean Sea. However, the strong showing of interest in the area from the international group of marine scientists who submitted white papers to and participated in that workshop was so impressive the Trust and its Nautilus Advisory Board decided to schedule a second year in this area of the world before moving on to the Pacific Ocean, as originally planned. This fifth Oceanography supplement chronicles the 2014 field season: four months of exploration in the Gulf of Mexico and the Caribbean Sea, as well as rapid growth in our science, technology, engineering, and mathematics (STEM) education and outreach programs and continued research on best practices of telepresence and archaeological oceanography