The Effect Of Problem Based Learning On Undergraduate Oral Communication Competency

Purpose:  The aim of this study was to ascertain the effect of Problem Based Learning (PBL) on student oral communication competency gains. Methods:  Eighty students from two consecutive undergraduate Kinesiology courses (Spring semesters, 2014-15) formed into 29 small groups and were studied.  Oral communication competency was assessed using a customized rubric and digital recordings of student presentations.  Changes to oral communication competency across time were tested using a dependent t-test; a < .05. Results:  Significant inter-rater agreement was found at both time points for oral communication rating, and student groups demonstrated significant oral communication gains across time.  Conclusions:  Collaborative learning was shown to improve students’ oral communication competency. Future study is required to determine the influence of student motivation and goal orientation on oral communication competency, in relation to the various phases of knowledge creation occurring within student groups.

Cell organization in soft media due to active mechanosensing

Adhering cells actively probe the mechanical properties of their environment and use the resulting information to position and orient themselves. We show that a large body of experimental observations can be consistently explained from one unifying principle, namely that cells strengthen contacts and cytoskeleton in the direction of large effective stiffness. Using linear elasticity theory to model the extracellular environment, we calculate optimal cell organization for several situations of interest and find excellent agreement with experiments for fibroblasts, both on elastic substrates and in collagen gels: cells orient in the direction of external tensile strain, they orient parallel and normal to free and clamped surfaces, respectively, and they interact elastically to form strings. Our method can be applied for rational design of tissue equivalents. Moreover our results indicate that the concept of contact guidance has to be reevaluated. We also suggest that cell-matrix contacts are upregulated by large effective stiffness in the environment because in this way, build-up of force is more efficient.Comment: Revtex, 7 pages, 4 Postscript files include

The use of specialty training to retain doctors in Malawi: A discrete choice experiment

Emigration has contributed to a shortage of doctors in many sub-Saharan African countries. Specialty training is highly valued by doctors and a potential tool for retention. Yet not all types of training may be valued equally. In the first study to examine preferences for postgraduate training in depth, we carried out a discrete choice experiment as part of a cross-sectional survey of all Malawian doctors within seven years of graduation and not yet in specialty training. Over August 2012 to March 2013, 148 doctors took part out of 153 eligible in Malawi. Despite evidence that specialty training is highly sought after, Malawian junior doctors would not accept all types of training. Doctors preferred timely training outside of Malawi in core specialties (internal medicine, general surgery, paediatrics, obstetrics & gynaecology). Specialty preferences are particularly strong, with most junior doctors requiring nearly double their monthly salary to accept training all in Malawi and over six-fold to accept training in ophthalmology (representing a bundle of unpopular but priority specialties). In contrast, the location of work before training did not significantly influence most doctors' choices when guaranteed specialty training. Using a latent class model, we identified four subgroups of junior doctors with distinct preferences. Policy simulations showed that these preferences could be leveraged by policymakers to improve retention in exchange for guaranteed specialty training, however incentivising the uptake of training in priority specialties will only be effective in those with more flexible preferences. These results indicate that indiscriminate expansion of postgraduate training to slow emigration of doctors from sub-Saharan African countries may not be effective unless doctors' preferences are taken into account

The ultimate arc: Differential displacement, oroclinal bending, and vertical axis rotation in the External Betic-Rif arc

The External Betic-Rif arc, which lies between the converging African and Iberian plates, is one of the tightest orogenic arcs on Earth. It is a thin-skinned fold and thrust belt formed in Miocene time around the periphery of the Alborán Domain, an older contractional orogen that underwent extensional collapse coevally with the formation of the thrust belt. Restoration of four sections across the thrust belt, together with kinematic and paleomagnetic analysis, allows a reconstruction of the prethrusting geometry of the Alborán Domain, and the identification of the following processes that contributed to the formation of the arc: (1) The Alborán Domain moved some 250 km westward relative to Iberia and Africa during the Miocene. This initiated the two limbs of the arc on its NW and SW margins, closing to the WSW in the region of Cherafat in northern Morocco. The overall convergence direction on the Iberian side of the arc was between 310° and 295°, and on the African side it was between 235° and 215°. The difference in convergence direction between the two sectors was primarily a result of the relative motion between Africa and Iberia. (2) Extensional collapse of the Alborán Domain during the Miocene modified the geometry of the western end of the arc: the Internal Rif rotated anticlockwise to form the present north trending sector of the arc, and additional components of displacement produced by extension were transferred into the external thrust belt along a series of strike-slip faults and shear zones. These allowed the limbs of the arc to rotate and extend, tightening the arc, and creating variations in the amounts and directions of shortening around the arc. The Betic sector of the arc rotated clockwise by 25° during this process, and the southern Rif rotated anticlockwise by ∼55°. (3) Oblique convergence on the two limbs of the arc, dextral in the Betics and sinistral in the southern Rif, resulted in strongly noncoaxial deformation. This had three related effects: (1) large rotations of individual thrust sheets resulted from the oblique propagation of thrusts away from the thrust front, followed by pinning and rotation as the thrust sheets peeled off, (2) continued oblique convergence resulted in distributed shear, particularly in the rear of the thrust wedge, causing rotation of stacks of thrust sheets on the scale of a few tens of kilometers, and (3) distributed shear in the orogen resulted in the rotation of folds as they amplified, the hinges migrating through the rock body, and rotating at a slower rate than the rock. These rotations were substantially larger than the bulk rotations of the limbs of the arc, and they strongly modified the orientations of folds, thrust traces, and the structural indicators of fault slip directions

COEXISTING PROSTATE CANCER FOUND AT THE TIME OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA: PREDICTING ITS PRESENCE AND GRADE IN ANALYZED TISSUE

Objective: To determine the incidence of prostate cancer identified on holmium laser enucleation of the prostate (HoLEP) specimens and evaluate variables associated with prostate cancer identification. Patients and Methods: All patients undergoing HoLEP between 1998 and 2013 were identified. Patients with a known history of prostate cancer were excluded. Multivariable logistic regression assessed variables associated with identification of prostate cancer on HoLEP specimens and Gleason 7 or higher prostate cancer among the malignant cases. The Gleason grade was used as a proxy for disease severity. Each of the models was adjusted for age, preoperative prostate-specific antigen (PSA), and HoLEP specimen weight. Results: The cohort comprised 1272 patients, of whom 103 (8.1%) had prostate cancer identified. Prostate cancer cases had higher pre-HoLEP PSA (p=0.06) but lower HoLEP specimen weight (p=0.01). On multivariate logistic regression, age and preoperative PSA were associated with increased odds of prostate cancer being present (p<0.01 each), while increasing HoLEP specimen weight was associated with decreased odds of prostate cancer (p<0.001). Men older than 80 had 20% predicted probability of being diagnosed with prostate cancer. Seventy-eight percent of prostate cancer cases were Gleason 6 or less. The pre-HoLEP PSA was associated with increased adjusted odds of intermediate- or high-grade prostate cancer. Conclusion: Prostate cancer identified by HoLEP is not uncommon, but is generally a low-risk disease. Older patients with smaller prostate glands have the highest odds of prostate cancer identification

Specialty training for the retention of Malawian doctors: A cost-effectiveness analysis

Few medical schools and sustained emigration have led to low numbers of doctors in many sub-Saharan African countries. The opportunity to undertake specialty training has been shown to be particularly important in retaining doctors. Yet limited training capacity means that doctors are often sent to other countries to specialise, increasing the risk that they may not return. Expanding domestic training, however, may be constrained by the reluctance of doctors to accept training in their home country. We modelled different policy options in an example country, Malawi, to examine the cost-effectiveness of expanding specialty training to retain doctors in sub-Saharan Africa. We designed a Markov model of the physician labour market in Malawi, incorporating data from graduate tracing studies in 2006 and 2012, a 2013 discrete choice experiment on 148 Malawian doctors and 2015 cost data. A government perspective was taken with a time horizon of 40 years. Expanded specialty training in Malawi or South Africa with increasing mandatory service before training was compared against baseline conditions. The outcome measures were cost per doctor-year and cost per specialist-year spent working in the Malawian public sector. Expanding specialty training in Malawi is more cost-effective than training outside Malawi. At least two years of mandatory service would be more cost-effective, with five years adding the most value in terms of doctor-years. After 40 years of expanded specialty training in Malawi, the medical workforce would be over fifty percent larger with over six times the number of specialists compared to current trends. However, the government would need to be willing to pay at least 3.5 times more per doctor-year for a 5% increase and a third more per specialist-year for a four-fold increase. Greater returns are possible from doctors with more flexible training preferences. Sustained funding of specialty training may improve retention in sub-Saharan Africa

Erosion and Accretion Trends of New Hampshire Beaches from December 2016 to March 2020: Results of the Volunteer Beach Profile Monitoring Program

New Hampshire Atlantic beaches were monitored from December 2016 to March 2020 to determine seasonal changes in morphology and elevation, assess the response of the beaches to storms with respect to erosion and subsequent recovery, and develop a baseline to determine long-term trends in beach size, elevation, and position. A unique aspect of this study was the involvement of community volunteers working together with the University of New Hampshire (UNH) Center for Coastal and Ocean Mapping, UNH Cooperative Extension, New Hampshire Sea Grant, and the New Hampshire Geological Survey. The monitoring network consisted of thirteen stations located at six of the major beaches, including each of the state beaches. Monitoring stations were located at Wallis Sands, Jenness Beach, North Hampton Beach, North Beach, Hampton Beach, and Seabrook Beach. At least two stations were located at each beach (Seabrook Beach had three stations). Beach elevation profiles were run routinely at each station at approximately three- to four-week intervals. Additional measurements were made following several major storms. In total, approximately 400 elevation profiles were run at the thirteen stations. The elevation profiles were run using the Emery (1961) method which utilizes two calibrated rods and the horizon for leveling. Sediment volume calculations were made for each profile that approximated the amount of material in the intertidal zone for that profile at that point in time for a one-meter wide swath of the beach. Seasonal changes and storm impacts on beach elevations, profile characteristics, and sediment volumes are discussed in detail for each beach and the major conditions and processes that control their stability discussed

The political views of doctors in the United Kingdom: A cross sectional study

Background: Little is known about the political views of doctors in the United Kingdom, despite their importance in the functioning of the National Health Service. Methods: Survey-based cross-sectional study in which we asked questions about voting behaviour in 2015 and 2017 UK general elections and 2016 referendum on leaving the European Union (Brexit) and questions relating to recent health policies. Results: 1,172 doctors (45.1% women) from 1,295 responded to an online survey. 60.5% described their political views as ‘left-wing’ and 62.2% described themselves as ‘liberal’. 79.4% of respondents voted to remain in the EU in the 2016 referendum compared to 48.1% of voters as a whole (χ2=819.8, p<0.001). 98.6% of respondents agreed that EU nationals working in the NHS should be able to remain in the UK after Brexit. The median score for the impact of Brexit on the NHS on a scale of 0 (worst impact) to 10 (best impact) was 2 (IQR=1-4). Most respondents agreed with the introduction of minimum alcohol pricing in the UK (73.9%), charging patients who are not eligible for NHS treatment for non-urgent care (70.6%) and protecting a portion of national spending for the NHS (87.1%). 65.8% thought there was too much use of NHS-funded private sector provision in their medical practice. Specialty, income and grade were associated with divergent opinions. Conclusions: UK doctors are left-leaning and liberal in general, which is reflected in their opinions on topical health policy issues. Doctors in the UK voted differently from the general electorate in recent polls