Teaching Medical Students Optimal Consulting Skills: The Challenge of Generating Better Referring Physicians.

Rationale and objectives We sought to incorporate a new teaching module into the traditional medical student radiology clerkship, to improve the necessary skills for future referring physicians. Materials and methods A new required and graded module was introduced in 2014 into the radiology clerkship in year three of medical school: the Mystery Case. Each student was provided a unique and undifferentiated case from a dedicated teaching file containing de-identified images and requisition data. Students were expected to complete three serial tasks over one week: 1) prepare a voice recognition-derived, structured radiological report utilizing appropriate and relevant vocabulary; 2) discuss pertinent additional clinical information; and 3) discuss appropriate follow-up imaging, in addition to information on how to best prepare patients for these potential patient exams (e.g., with or without contrast, bowel preparation, and length of study). Students were provided written examples and dedicated class instruction with interactive discussions covering specific cases and associated related cases through random pairing with radiology resident and attending mentors. At the close of the week, students gave brief oral presentations of their cases and submitted the tasks for a written evaluation. Upon completion of the clerkship, the students completed a Likert-type six-item survey to evaluate the perceived improvement in select skills. Results The survey was completed by 82% (54/66) of the enrolled students, with 85% finding the Mystery Case an effective use of time. Medical students perceived an improved awareness of the patient care process (77%), awareness of the medical imaging resources available (89%), ability to understand a radiology report (74%), and ability to advise patients (69%). Conclusion Introduction of the Mystery Case as a graded exercise in the medical school radiology clerkship was perceived by students as effective use of time, with an improvement in the skills essential for future referring physicians

Ecological Aspects of a Wood Turtle, Glyptemys insculpta, Population at the Northern Limit of its Range in Québec

As part of a conservation research initiative, a population of Wood Turtles (Glyptemys insculpta) at the northern limit of its range was studied to ascertain characteristics of its demographics, morphometrics, density, mortality, feeding, and mating activities. Turtles were captured and marked during the activity period in 1996 and 1997. In addition, 20 individuals were radio-tracked weekly. A total of 188 turtles was captured and the size of the population in the study area was estimated at 238 turtles. The estimated population density based on this calculation is 0.44 turtles/ha. This is less than other studies indicating that population densities are greater in southern populations. Turtles from this population were large (carapace length of males=214.5 ± 4.21 mm, females=201.1 ± 10.88 mm) which supports the hypothesis that turtle size is negatively correlated with number of frost free days. The sex ratio was not significantly different from 1:1. Juvenile turtles accounted for 31.4% of the population. Observations of feeding habits support the claim that Wood Turtles are opportunistic omnivores. Of the 35 mating or courtship events observed, 77 % occurred in the fall and half of them between 11:00 and 13:00. Although limb and tail injuries and parasites were observed on many turtles, no dead turtles were observed. This last result, combined with the high rate of recruitment and even sex ratio suggests that this population is stable, making it an ideal population with which to make comparisons with other studies in areas where the species could be in decline

Towards a terramechanics for bio-in spired locomotion in granular environments

Granular media (GM) present locomotor challenges for terrestrial and extraterrestrial devices because they can flow and solidify in response to localized intrusion of wheels, limbs and bodies. While the development of airplanes and submarines is aided by understanding of hydrodynamics, fundamental theory does not yet exist to describe the complex interactions of locomotors with GM. In this paper, we use experimental, computational, and theoretical approaches to develop a terramechanics for bio-inspired locomotion in granular environments. We use a fluidized bed to prepare GM with a desired global packing fraction, and use empirical force measurements and the Discrete Element Method (DEM) to elucidate interaction mechanics during locomotion-relevant intrusions in GM such as vertical penetration and horizontal drag. We develop a resistive force theory (RFT) to account for more complex intrusions. We use these force models to understand the locomotor performance of two bio-inspired robots moving on and within GM. The sponsor was DARPA/SPAWAR N66001–05-C-8025. For further information, visit Kod*lab

Driving habits and reaction times on a driving simulation in older drivers with chronic heart failure

Judgement and reaction times during complex tasks like driving may be impaired in older adults with chronic heart failure (HF). This study sought to report the driving habits and reaction times of older patients with HF in a specially designed urban driving simulation. We conducted a prospective observational study in HF patients and controls. Patients in both groups underwent cognitive testing and screening for depression. Current drivers undertook questionnaire regarding driving habits followed by an urban road driving simulation consisting of three laps. Five separate hazards appeared in the third lap without warning. Reaction times and stopping distances to the hazards were calculated. Of 247 patients with HF approached for the study, 124 had already voluntarily stopped driving due to HF (n=92) or other medical conditions (n=32), 60 had never had a license, and 32 declined to participate. Of the 74 controls approached, 1 was not currently driving due to a medical condition, and 46 declined to participate. Patients in both groups had similar levels of cognitive function, mood and driving habits. 30 patients with HF [mean (SD) age 74 (±5) years, median (IQR) NT-proBNP 1510 (546-3084) pg/L] and 26 controls [mean age 73 (±5) years, median NT-proBNP 135 (73-182) pg/L] completed the simulation. During lap 3, there was no difference in the driving speed between patients (mean 22.0 SD 4.5 mph) and controls (mean 21.7 SD3.3 mph; p=0.80). Patients had longer reaction times [median 1.10 (IQR 0.98-1.30) seconds) than controls [median 0.96 (IQR 0.83-1.10) seconds, p=0.02], but there was no difference in stopping distances [patients: median 43.9 (IQR 32.2- 49.5) metres; controls: median 38.1 (IQR 32.3-48.8) metres, p=0.31)]. Many older adults with HF no longer drive. Those who continue to drive appear safe to drive on simulated urban roads

Stereoselective synthesis of hydroxylated 3-aminoazepanes using a multi-bond forming, three-step tandem process

A multi-bond forming, three-step tandem process involving a palladium(II)-catalysed Overman rearrangement and a ring closing metathesis reaction has been utilised for the efficient synthesis of a 2,3,6,7-tetrahydro-3-amidoazepine. Substrate directed epoxidation or dihydroxylation of this synthetic intermediate has allowed the diastereoselective synthesis of hydroxylated 3-aminoazepanes including the syn-diastereomer of the balanol core. Asymmetric synthesis of the 2,3,6,7-tetrahydro-3-amidoazepine motif was also achieved using a chiral palladium(II)-catalyst during the Overman rearrangement

Experimental discovery of sRNAs in Vibrio cholerae by direct cloning, 5S/tRNA depletion and parallel sequencing

Direct cloning and parallel sequencing, an extremely powerful method for microRNA (miRNA) discovery, has not yet been applied to bacterial transcriptomes. Here we present sRNA-Seq, an unbiased method that allows for interrogation of the entire small, non-coding RNA (sRNA) repertoire in any prokaryotic or eukaryotic organism. This method includes a novel treatment that depletes total RNA fractions of highly abundant tRNAs and small subunit rRNA, thereby enriching the starting pool for sRNA transcripts with novel functionality. As a proof-of-principle, we applied sRNA-Seq to the human pathogen Vibrio cholerae. Our results provide information, at unprecedented depth, on the complexity of the sRNA component of a bacterial transcriptome. From 407 039 sequence reads, all 20 known V. cholerae sRNAs, 500 new, putative intergenic sRNAs and 127 putative antisense sRNAs were identified in a limited number of growth conditions examined. In addition, characterization of a subset of the newly identified transcripts led to the identification of a novel sRNA regulator of carbon metabolism. Collectively, these results strongly suggest that the number of sRNAs in bacteria has been greatly underestimated and that future efforts to analyze bacterial transcriptomes will benefit from direct cloning and parallel sequencing experiments aided by 5S/tRNA depletion

Design optimisation of an offshore vertical axis wind turbine

Horizontal axis wind turbines have a number of limitations for offshore operations, particularly in deep water (i.e. over 50 m). For example, scalability restrictions, the necessity for high lift installations offshore requiring specialist vessels, high gravitational and aerodynamic moments on the support structure and a need to maintain rotary equipment at heights typically over 60–80 m. Conversely, vertical axis wind turbines have several inherent attributes that offer some advantages for offshore operations, particularly their scalability and low over-turning moments with better accessibility to drivetrain components. This paper describes the aerodynamic optimisation of a novel 10 MW vertical axis wind turbine rotor shape offering a low-stress design to minimise manufacturing and maintenance costs of the whole turbine assembly including the supporting structure and foundations. The Aerogenerator vertical axis wind turbine is self-supporting so does not require a supporting tower, giving a low centre of gravity and producing significantly lower aerodynamic over-turning moments than conventional vertical axis wind turbines or horizontal axis wind turbines, making it a credible option for a floating, deep water platform. A numerical optimisation procedure is described to minimise the Aerogenerator weight while imposing aerodynamic, mechanical and structural side constraints. The study proposes a novel ‘sycamore’-shaped rotor design that demonstrates a lower cost of energy compared with conventional offshore turbines

Slaughterhouse Wastewater Treatment by Combined Chemical Coagulation and Electrocoagulation Process

Slaughterhouse wastewater contains various and high amounts of organic matter (e.g., proteins, blood, fat and lard). In order to produce an effluent suitable for stream discharge, chemical coagulation and electrocoagulation techniques have been particularly explored at the laboratory pilot scale for organic compounds removal from slaughterhouse effluent. The purpose of this work was to investigate the feasibility of treating cattle-slaughterhouse wastewater by combined chemical coagulation and electrocoagulation process to achieve the required standards. The influence of the operating variables such as coagulant dose, electrical potential and reaction time on the removal efficiencies of major pollutants was determined. The rate of removal of pollutants linearly increased with increasing doses of PACl and applied voltage. COD and BOD5 removal of more than 99% was obtained by adding 100 mg/L PACl and applied voltage 40 V. The experiments demonstrated the effectiveness of chemical and electrochemical techniques for the treatment of slaughterhouse wastewaters. Consequently, combined processes are inferred to be superior to electrocoagulation alone for the removal of both organic and inorganic compounds from cattle-slaughterhouse wastewater

Feasibility, design and conduct of a pragmatic randomized controlled trial to reduce overweight and obesity in children: The electronic games to aid motivation to exercise (eGAME) study

<p>Abstract</p> <p>Background</p> <p>Childhood obesity has reached epidemic proportions in developed countries. Sedentary screen-based activities such as video gaming are thought to displace active behaviors and are independently associated with obesity. Active video games, where players physically interact with images onscreen, may have utility as a novel intervention to increase physical activity and improve body composition in children. The aim of the Electronic Games to Aid Motivation to Exercise (eGAME) study is to determine the effects of an active video game intervention over 6 months on: body mass index (BMI), percent body fat, waist circumference, cardio-respiratory fitness, and physical activity levels in overweight children.</p> <p>Methods/Design</p> <p>Three hundred and thirty participants aged 10–14 years will be randomized to receive either an active video game upgrade package or to a control group (no intervention).</p> <p>Discussion</p> <p>An overview of the eGAME study is presented, providing an example of a large, pragmatic randomized controlled trial in a community setting. Reflection is offered on key issues encountered during the course of the study. In particular, investigation into the feasibility of the proposed intervention, as well as robust testing of proposed study procedures is a critical step prior to implementation of a large-scale trial.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trials Registry ACTRN12607000632493</p