Improving Advanced Care Planning Discussion and Documentation

Our goal is to improve ACP discussion and documentation in patients above the age of 65 in our Jefferson Hospital Ambulatory Practice (JHAP) resident clinic. By instituting procedural changes within the EMR and the clinic, as well as improving provider education, we hope that residents can carry out a comprehensive and streamlined discussion regarding advanced care planning. We will institute these changes over the next 3 months, and we predict that there will be an increase in ACP discussion and uploading of appropriate documentation to 50% and 25%, respectively

Response to rapidly changing healthcare information regarding COVID-19 with virtual journal club

Virtual twice weekly COVID-19 journal club (JC) created to optimize residency and faculty education regarding COVID-19 management, critical appraisal of new literature, and improve departmental collaboration and connection

Prevalence, characteristics, and impacts of work-related musculoskeletal disorders: a survey among physical therapists in the State of Kuwait

<p>Abstract</p> <p>Background</p> <p>Physical therapists working in the State of Kuwait are at risk of work-related musculoskeletal disorders (WMSDs). However, prevalence rates and risk factors are not well documented. The objective of this study was to determine the prevalence, characteristics, and impacts of WMSDs among physical therapists in the State of Kuwait.</p> <p>Methods</p> <p>A self-administered questionnaire was distributed to 350 physical therapists. The questionnaire gathered demographic data as well as information on occurrence of musculoskeletal complaints in the previous 12 months. Descriptive statistics, frequency, and Chi-square analyses were used.</p> <p>Results</p> <p>The response rate to the questionnaire was 63% (222/350). Of the 212 responders included in the study, the one-year prevalence of WMSDs was 47.6%, with lower back complaints as the most common (32%). This was followed by neck (21%), upper back (19%), shoulder (13%), hand/wrist (11%), knee (11%), ankle/foot (6%), elbow (4%), and hip/thigh (3%) complaints. The frequency of WMSDs was not gender related (except lower back, neck, and shoulder complaints) nor was it related to age (except lower back complaints), working venues (except hand/wrist), working hours, area of specialty, or exercise. WMSDs' impact on work was minor.</p> <p>Conclusions</p> <p>WMSDs among physical therapists in Kuwait were common, with lower back and neck affected most. Lower back and neck WMSDs were related to the participant's demographics. Hand/wrist WMSDs were related to work settings. Further research is needed to investigate the effect of risk factors as physical load, psychosocial load, and general health status on prevalence musculoskeletal disorders.</p

Gestural communication of the gorilla (Gorilla gorilla): repertoire, intentionality and possible origins

Social groups of gorillas were observed in three captive facilities and one African field site. Cases of potential gesture use, totalling 9,540, were filtered by strict criteria for intentionality, giving a corpus of 5,250 instances of intentional gesture use. This indicated a repertoire of 102 gesture types. Most repertoire differences between individuals and sites were explicable as a consequence of environmental affordances and sampling effects: overall gesture frequency was a good predictor of universality of occurrence. Only one gesture was idiosyncratic to a single individual, and was given only to humans. Indications of cultural learning were few, though not absent. Six gestures appeared to be traditions within single social groups, but overall concordance in repertoires was almost as high between as within social groups. No support was found for the ontogenetic ritualization hypothesis as the chief means of acquisition of gestures. Many gestures whose form ruled out such an origin, i.e. gestures derived from species-typical displays, were used as intentionally and almost as flexibly as gestures whose form was consistent with learning by ritualization. When using both classes of gesture, gorillas paid specific attention to the attentional state of their audience. Thus, it would be unwarranted to divide ape gestural repertoires into ‘innate, species-typical, inflexible reactions’ and ‘individually learned, intentional, flexible communication’. We conclude that gorilla gestural communication is based on a species-typical repertoire, like those of most other mammalian species but very much larger. Gorilla gestures are not, however, inflexible signals but are employed for intentional communication to specific individuals

Graz. Schloßberg.

Blick zum Schloßberg mit Hauptbrück

Variation in the Meaning of Alarm Calls in Verreaux’s and Coquerel’s Sifakas (Propithecus verreauxi, P. coquereli)

The comprehension and usage of primate alarm calls appear to be influenced by social learning. Thus, alarm calls provide flexible behavioral mechanisms that may allow animals to develop appropriate responses to locally present predators. To study this potential flexibility, we compared the usage and function of 3 alarm calls common to 2 closely related sifaka species (Propithecus verreauxi and P. coquereli), in each of 2 different populations with different sets of predators. Playback studies revealed that both species in both of their respective populations emitted roaring barks in response to raptors, and playbacks of this call elicited a specific anti-raptor response (look up and climb down). However, in Verreaux’s sifakas, tchi-faks elicited anti-terrestrial predator responses (look down, climb up) in the population with a higher potential predation threat by terrestrial predators, whereas tchi-faks in the other population were associated with nonspecific flight responses. In both populations of Coquerel’s sifakas, tchi-fak playbacks elicited anti-terrestrial predator responses. More strikingly, Verreaux’s sifakas exhibited anti-terrestrial predator responses after playbacks of growls in the population with a higher threat of predation by terrestrial predators, whereas Coquerel’s sifakas in the raptor-dominated habitat seemed to associate growls with a threat by raptors; the 2 other populations of each species associated a mild disturbance with growls. We interpret this differential comprehension and usage of alarm calls as the result of social learning processes that caused changes in signal content in response to changes in the set of predators to which these populations have been exposed since they last shared a common ancestor

Communication : where evolutionary linguistics went wrong

In this article we offer a detailed assessment of current approaches to the origins of language, with a special focus on their historical and theoretical underpinnings. It is a widely accepted view within evolutionary linguistics that an account of the emergence of human language necessarily involves paying special attention to its communicative function and its relation to other animal communication systems. Ever since Darwin, some variant of this view has constituted the mainstream version in evolutionary linguistics; however, it is our contention in this article that this approach is seriously flawed, and that "animal communication" does not constitute a natural kind on which a sound theoretical model can be built. As a consequence, we argue that this communicative perspective is better abandoned in favor of a structural/formal approach based on the notion of homology, and that some interesting and unexpected similarities may be found by applying this venerable comparative method founded in the 19th century by Richard Owen

Family physicians\u27 professional identity formation: a study protocol to explore impression management processes in institutional academic contexts.

BACKGROUND: Despite significant differences in terms of medical training and health care context, the phenomenon of medical students\u27 declining interest in family medicine has been well documented in North America and in many other developed countries as well. As part of a research program on family physicians\u27 professional identity formation initiated in 2007, the purpose of the present investigation is to examine in-depth how family physicians construct their professional image in academic contexts; in other words, this study will allow us to identify and understand the processes whereby family physicians with an academic appointment seek to control the ideas others form about them as a professional group, i.e. impression management. METHODS/DESIGN: The methodology consists of a multiple case study embedded in the perspective of institutional theory. Four international cases from Canada, France, Ireland and Spain will be conducted; the \u22case\u22 is the medical school. Four levels of analysis will be considered: individual family physicians, interpersonal relationships, family physician professional group, and organization (medical school). Individual interviews and focus groups with academic family physicians will constitute the main technique for data generation, which will be complemented with a variety of documentary sources. Discourse techniques, more particularly rhetorical analysis, will be used to analyze the data gathered. Within- and cross-case analysis will then be performed. DISCUSSION: This empirical study is strongly grounded in theory and will contribute to the scant body of literature on family physicians\u27 professional identity formation processes in medical schools. Findings will potentially have important implications for the practice of family medicine, medical education and health and educational policies