Learning clinical communication on ward-rounds: an ethnographic case study.

OBJECTIVE: To explore what factors influence student-doctors' learning of clinical communication on ward-rounds and how such learning can be enhanced. METHODS: Adopting a qualitative ethnographic approach, the author audio recorded and observed 63 bedside episodes within 18 ward-rounds on four different wards over an 8-week period. Nine fourth year student-doctors and four clinicians also participated in semi-structured interviews. The combination of observations, audio-recordings, transcriptions, field notes, and interview data allowed us to produce a detailed description of the case. RESULTS: Each bedside episode offered opportunities for learning about clinical communication. However, the student-doctors did not always recognise that they were learning about clinical communication, since in this context, they were not being explicitly taught about communication. Student-doctors were rarely invited to participate in the ward-round and clinicians overlooked opportunities for learning. Some student-doctors questioned the educational value of ward-rounds and did not always attend. CONCLUSIONS: Ward-rounds are a rich site for learning clinical communication but opportunities for learning are often overlooked. PRACTICE IMPLICATIONS: By being alert to the power of role modelling and the importance of inclusion and participation, student-doctors' learning of clinical communication can be enhanced even on busy ward rounds.This is the final published version of the article and will be under embargo until the 26th of August 2015. This version was first published in Medical Teacher here: http://informahealthcare.com/doi/abs/10.3109/0142159X.2014.947926

Cumulative light curves of gamma-ray bursts and relaxation systems

The cumulative light curves of a large sample of gamma-ray bursts (GRBs) were obtained by summing the BATSE counts. The smoothed profiles are much simpler than the complex and erratic running light curves that are normally used. For most GRBs the slope of the cumulative light curve (S) is approximately constant over a large fraction of the burst. The bursts are modelled as relaxation systems that continuously accumulate energy in the reservoir and discontinuously release it. The slope is a measure of the cumulative power output of the central engine. A plot of S versus peak flux in 64ms (P64ms) shows a very good correlation over a wide range for both short and long GRBs. No relationship was found between S and GRBs with known redshift. The standard slope (S'), which is representative of the power output per unit time, is correlated separately with P64ms for both sub-classes indicating more powerful outbursts for the short GRBs. S' is also anticorrelated with GRB duration. These results imply that GRBs are powered by accretion into a black hole.Comment: 4 pages, 2 figures. Accepted for publication in Astronomy and Astrophysics Letter

Temporal properties of short and long gamma-ray bursts

A temporal analysis was performed on a sample of 100 bright short GRBs with T90 < 2s from the BATSE Current Catalog along with a similar analysis on 319 long bright GRBs with T90 > 2s from the same catalog. The short GRBs were denoised using a median filter and the long GRBs were denoised using a wavelet method. Both samples were subjected to an automated pulse selection algorithm to objectively determine the effects of neighbouring pulses. The rise times, fall times, FWHM, pulse amplitudes and areas were measured and their frequency distributions are presented. The time intervals between pulses were also measured. The frequency distributions of the pulse properties were found to be similar and consistent with lognormal distributions for both the short and long GRBs. The time intervals between the pulses and the pulse amplitudes of neighbouring pulses were found to be correlated with each other. The same emission mechanism can account for the two sub-classes of GRBs.Comment: 3 pages, 8 figures; Proceedings of "Gamma-Ray Burst and Afterglow Astronomy 2001", Woods Hol

Wavelet Analysis and Lognormal Distributions in GRBs

A wavelet analysis has been performed on 80 intense gamma-ray bursts GRBs) from the BATSE 3B catalog with durations longer than 2 seconds. The wavelet analysis applied novel features developed for edge detection in image processing and this filtering process was used to extract a fit to the irregular GRB profile from the background. A straightforward algorithm was subsequently used to identify statistically significant peaks in this profile. The areas and FWHM of 270 peaks that were characterised as isolated were found to be consistent with lognormal distributions. The distribution of time intervals between peak maxima for all 963 identified peaks in the GRBs is also presented.Comment: 5 pages, 4 figure

In the lion's den? Experiences of interaction with research ethics committees

Research ethics review is an important process, designed to protect participants in medical research. However, it is increasingly criticised for failing to meet its aims. Here, two researchers reflect on their experiences of applying for ethical approval of observational research in clinical settings. They highlight some problems faced by reviewers and researchers and propose a two-stage ethical review process that would alert researchers to the committee's concerns and allow them to give a more considered response

A Radiation Hardened by Design CMOS ASIC for Thermopile Readouts

A radiation hardened by design (RHBD) mixed-signal application specific integrated circuit (ASIC) has been designed for a thermopile readout for operation in the harsh Jovian orbital environment. The multi-channel digitizer (MCD) ASIC includes 18 low noise amplifier channels which have tunable gain/filtering coefficients, a 16-bit sigma-delta analog-digital converter (SDADC) and an on-chip controller. The 18 channels, SDADC and controller were designed to operate with immunity to single event latchup (SEL) and to at least 10 Mrad total ionizing dose (TID). The ASIC also contains a radiation tolerant 16-bit 20 MHz Nyquist ADC for general purpose instrumentation digitizer needs. The ASIC is currently undergoing fabrication in a commercial 180 nm CMOS process. Although this ASIC was designed specifically for the harsh radiation environment of the NASA led JEO mission it is suitable for integration into instrumentation payloads 011 the ESA JUICE mission where the radiation hardness requirements are slightly less stringent

Lidar Luminance Quantizer

This innovation addresses challenges in lidar imaging, particularly with the detection scheme and the shapes of the detected signals. Ideally, the echoed pulse widths should be extremely narrow to resolve fine detail at high event rates. However, narrow pulses require wideband detection circuitry with increased power dissipation to minimize thermal noise. Filtering is also required to shape each received signal into a form suitable for processing by a constant fraction discriminator (CFD) followed by a time-to-digital converter (TDC). As the intervals between the echoes decrease, the finite bandwidth of the shaping circuits blends the pulses into an analog signal (luminance) with multiple modes, reducing the ability of the CFD to discriminate individual event

Auto-Zero Differential Amplifier

An autozero amplifier may include a window comparator network to monitor an output offset of a differential amplifier. The autozero amplifier may also include an integrator to receive a signal from a latched window comparator network, and send an adjustment signal back to the differential amplifier to reduce an offset of the differential amplifier

Enabling fourth year student-doctors to learn through participation on ward rounds : an action research study

This thesis develops the concept of apprenticeship to capture and explore how the learning of\ud student doctors takes place in hospital ward rounds, with the aim of developing pedagogical\ud approaches that enable and improve learning. The research pays particular attention to the\ud shifting complexities of the hospital and ward-round environment and the ambiguous status\ud of student-doctors as participants.\ud Using action research the study sets up a collaborative inquiry with eleven student-doctors\ud who use audio-diaries and reflective learning sessions to harness learning from ward-round\ud experiences, explore the nature of their participation and facilitate critical reflection both on\ud and through the workplace. Exploration enables the student-doctors to see that learning\ud needs to be understood not simply as an intellectual activity but as participation in social\ud practice and that this necessitates focusing upon development of their agency and\ud professional identity.\ud Changes were identified at three levels: in the student-doctors' practice, in their\ud understandings of practice and in the conditions under which they practised. Nine of the\ud students were enabled to learn through active participation on the ward round. Eight studentdoctors\ud came to understand they were learning about becoming a doctor. By changing their\ud own understandings of forms of knowledge, of their role and opportunities for learning they\ud influenced the way other clinicians responded to them and were offered more opportunities\ud to participate.\ud The thesis as a whole represents an original and distinct contribution to the growing sociocultural\ud literature in medical education and specifically points to the need for changes in the\ud way learning in the workplace is conceptualised. It challenges medical educators and policy\ud makers to think not just about the individual, but also the culture and power relationships\ud which shape select and legitimise what learning affordances the student-doctors attend to;\ud that is the relational interdependence between personal and social agency.\u