bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial neural networks for simulating wind effects on sprinkler distribution patterns
Authors: Sayyadi H. , Sadraddini A. A. , Farsadi Zadeh D. , Montero J.
Published: November 2012

A new approach based on Artificial Neural Networks (ANNs) is presented to simulate the effects of wind on the distribution pattern of a single sprinkler under a center pivot or block irrigation system. Field experiments were performed under various wind conditions (speed and direction). An experimental data from different distribution patterns using a Nelson R3000 Rotator® sprinkler have been split into three and used for model training, validation and testing. Parameters affecting the distribution pattern were defined. To find an optimal structure, various networks with different architectures have been trained using an Early Stopping method. The selected structure produced R2= 0.929 and RMSE = 6.69 mL for the test subset, consisting of a Multi-Layer Perceptron (MLP) neural network with a backpropagation training algorithm; two hidden layers (twenty neurons in the first hidden layer and six neurons in the second hidden layer) and a tangent-sigmoid transfer function. This optimal network was implemented in MATLAB® to develop a model termed ISSP (Intelligent Simulator of Sprinkler Pattern). ISSP uses wind speed and direction as input variables and is able to simulate the distorted distribution pattern from a R3000 Rotator® sprinkler with reasonable accuracy (R2> 0.935). Results of model evaluation confirm the accuracy and robustness of ANNs for simulation of a single sprinkler distribution pattern under real field conditions.
Effects of inclusion of sorghum distillers dried grains with solubles (DDGS) in diets for growing and finishing pigs
Authors: Cerisuelo A. , Moset V. , Bonet J. , Coma J. , Lainez M.
Published: November 2012

The effects of sorghum distillers dried grains with solubles (sorghum-DDGS) in growing pig diets on growth performance and carcass quality were investigated. A total of 204 animals of 13.9±2.60 kg body weight (BW) were allocated into two dietary treatments, a conventional diet (C) and a diet containing sorghum-DDGS (DDGS). DDGS inclusion levels used were 150 g kg-1 in pigs from 14-40 kg BW, 300 g kg-1 from 40-80 kg BW and 350 g kg-1 from 80 kg BW to slaughter. Animals’ body weight, feed intake, backfat thickness (BF) and loin depth (LD) were measured throughout the study. Protein, fibre and fat content of sorghum-DDGS were approximately three times-fold those of the whole grain. During the nursery period, feed intake and final BW tended to be lower in the group of pigs fed DDGS compared to the piglets fed C diet (871.4 g d-1 and 30 kg vs 951.1 g d-1 and 31 kg). During the growing period no differences were found on growth performance between treatments. Pigs fed sorghum-DDGS showed higher BF than pigs fed C diet (10.96 mm vs 9.80 mm, p<0.001). No differences were found on LD and carcass weight and yield between treatments. Thus, although 150 g kg-1 of sorghum-DDGS in nursery diets tended to reduce growth performance, inclusion rates up to 300-350 g kg-1 during the finishing phase did not affect it, but led to fatter carcasses.
Planting density affects vigour and production of ‘Arbequina’ olive
Authors: Larbi A. , Ayadi M. , Ben Dhiab A. , Msallem M. , Caballero J. M.
Published: November 2012

The hedgerow orchard type is being increasingly used with the olive although not much information is still available about its suitability to this species. The objective of this study was to assess the influence of planting density (312, 416, 625 and 1,250 trees ha-1) on vigour and productive characteristics of ‘Arbequina’ olive trees planted in 2003. Significant linear regressions have been observed between planting density and tree width, trunk cross section area and canopy volume. Increasing planting density showed positive linear correlation (R2=0.63) with canopy volume per hectare. There was a negative correlation between planting density and production per tree in the five first crops, but it was positive with production per hectare both in olive and olive oil production with coefficients of determination ranging from 0.16 to 0.43 and from 0.28 to 0.46, respectively. A significant linear regression (R2= 0.31 and 0.48) was found between planting density and fruit size on two of the studied cropping years. Our results have not allowed establishing any relationship between planting density and fruit oil content. Finally, the studied densities did not affect the oil fatty acid composition. The production increase observed at the highest tried density is linked to the increase in canopy volume per hectare, but these results should be checked at later stages of tree development, as this study covers only until the fifth harvested crop.
Evaluación de la calidad del suelo tras la implantación de cubiertas permanentes en viñedos de zonas semiáridas. Materia orgánica y propiedades físicas y biológicas del suelo
Authors: Virto I. , Imaz M. J. , Fernández-Ugalde O. , Urrutia I. , Enrique A. , Bescansa P.
Published: November 2012

El establecimiento de cubiertas vegetales permanentes (PGC) en viñedos de zonas semiáridas, con manejo tradicional de suelo desnudo mediante laboreo y aplicación de herbicidas, es controvertido, porque tiene ventajas agronómicas y ambientales, pero puede inducir cambios negativos en la calidad física del suelo. Los objetivos de este trabajo fueron: (i) avanzar en el conocimiento del efecto de la implantación de PGC en la calidad física y biológica del suelo, e (ii) identificar los indicadores de calidad del suelo más apropiados para suelos calizos de viñedo en una zona semiárida. Se determinaron propiedades físicas y biológicas clave en un Calcisol Cámbico con PGC de diferente edad (1 y 5 años), con un control manejado convencionalmente. El análisis de correlaciones mostró una relación directa entre la estabilidad estructural (WSA), la capacidad de retención de agua útil (AWC), la biomasa microbiana y las actividades enzimáticas del suelo bajo PGC. El contenido de C orgánico total (SOC) y lábil (POM-C) estuvo también correlacionado con los parámetros microbianos. Los indicadores de calidad del suelo más sensibles se identificaron mediante análisis factorial por componentes principales (PCA). La actividad de lombrices, AWC, WSA, SOC y POM-C mostraron el mayor peso en los dos factores obtenidos con PCA, por lo que estas propiedades pueden considerarse indicadores adecuados de la calidad del suelo en este agrosistema. Estos resultados indican que tanto los atributos físicos como biológicos del suelo son diferentes bajo PGC, y necesitan ser evaluados al estudiar las consecuencias de su introducción en suelos de viñedo.
Eight-fold Interpenetrating Diamond-like Metal-Organic Frameworks Constructed with an N- and O-Donor Ligand for Cadmium(II) and Manganese(II)
Authors: Cheng Xiao-Chun , Zhu Xiao-Hong , Kuai Hai-Wei
Published: November 2012

Hydrothermal reactions of (E)-4-(2-(1H-imidazol-4-yl)vinyl)benzoic acid (HL) with Cd(II) and Mn(II) salts yield the complexes [Cd(L)2] (1) and [Mn(L)2] (2), which have been characterized by single-crystal and powder X-ray diffraction, IR spectroscopy, and elemental and thermogravimetric analyses. Complexes 1 and 2 are isomorphous and isostructural, displaying an uninodal 4-connected 8-fold interpenetrating 3D dia framework architecture with (66) topology. These frameworks exhibit high thermal stability up to 400 °C. The luminescence and non-linear optical (NLO) properties were investigated.
Synthesis, Characterization, and Magnetic Properties of Two New Co(II) Coordination Polymers with a Carboxylate- and Benzimidazolylcontaining Ligand
Authors: Cheng Xiao-Chun , Kuai Hai-Wei
Published: November 2012

The hydrothermal reaction of cobalt(II) nitrate hexahydrate with 5-(benzimidazol-1- ylmethyl)isophthalic acid (H2L) leads to the formation of a complex [Co(L)] (1). In the presence of 2-(pyridin-2-yl)-1H-benzimidazole (pybim) as an auxiliary ligand, a complex [Co(L)(pybim)]·H2O (2) was obtained. The complexes 1 and 2 have been characterized by single-crystal and powder X-ray diffraction, IR spectroscopy, and elemental and thermogravimetric analyses. Complex 1 shows a binodal (3,6)-connected 2D kgd network with (43)2(46·66·83) topology; 2 shows a chain structure, further linked together by hydrogen bonding and π-π interactions to give rise to a 3D supramolecular framework. Complexes 1 and 2 are examples of auxiliary ligand-assisted structural diversity. The frameworks of 1 and 2 display high thermal stability up to 400 °C. The magnetic properties of 1 were investigated.
Aminkomplexe von Silber(I)-disulfonylamiden, Teil II: Anilinkomplexe [1, 2]/ Amine Complexes of Silver(I) Disulfonylamides, Part II: Aniline Complexes
Authors: Zerbe Eva-Maria , Wölper Christoph , Jones Peter G.
Published: November 2012

We report the first crystal structures of aniline complexes of silver, namely the three anilinecomplexed silver(I) disulfonylamides 1 (aniline)(dimesylamido)silver(I), 2 bis(aniline)(1,1,3,3- tetraoxo-1,3,2-benzodithiazolido)silver(I) and 3 bis(aniline)silver(I) [di(p-bromobenzenesulfonyl)- amide] : aniline (1 : 1). Compound 1 is molecular, with approximately linear coordination at silver; the coordination is extended to T-shaped by an Ag···O contact of 2.7136(11) Å to a neighbouring molecule related by a axis translation. Compound 2 is molecular, with trigonal planar coordination geometry at silver. Compound 3 is ionic, with exactly linear coordination at each of the two independent silver atoms, both of which occupy inversion centres; the third aniline is not coordinated to the silver atoms. Classical hydrogen bonds are the main feature of the packing diagrams for all three compounds. The packing of 1 and 2 can be analysed in terms of hydrogen-bonded dimers, further linked to form ribbons parallel to the a axis. In 3, the cations and anions are linked to form zigzag chains parallel to the b axis, and these are further linked to form a layer structure parallel to (001). The free aniline molecules are hydrogen bonded above and below the layer.
Isolation, Structure, Synthesis and Cytotoxicity of an Unprecedented Flupirtine Dimer
Authors: Csuk René , Sommerwerk Sven , Wiese Jana , Wagner Christoph , Siewert Bianka , Kluge Ralph , Ströhl Dieter
Published: November 2012

A previously unknown dimer of the well-established analgesic flupirtine has been found, and its structure was revealed by ESI-MS, NMR spectroscopy and an independent synthesis. Thus, starting from 2-amino-6-chloro-3-nitro-pyridine the target compound was obtained in a four-step synthesis. Key-step of this synthesis is a nickel-mediated aryl-aryl coupling. The dimer 4 did not show any cytotoxicity, and its IC50 values were > 30 μm for all six human cancer cell lines and mouse fibroblasts used in this study
Root Cause Analysis of Problems in the Frozen Section Diagnosis of In Situ, Minimally Invasive, and Invasive Adenocarcinoma of the Lung
Authors: Walts Ann E. , Marchevsky Alberto M.
Published: November 2012

Context.—Frozen sections can help determine the extent of surgery by distinguishing in situ, minimally invasive, and invasive adenocarcinoma of the lung.

Objective.—To evaluate our experience with the frozen section diagnosis of these lesions using root-cause analysis.

Design.—Frozen sections from 224 consecutive primary pulmonary adenocarcinomas (in situ, 27 [12.1%]; minimally invasive, 46 [20.5%]; invasive, 151 [67.4%]) were reviewed. Features that could have contributed to frozen section errors and deferrals were evaluated.

Results.—There were no false-positive diagnoses of malignancy. Frozen section errors and deferrals were identified in 12.1% (27 of 224) and 6.3% (14 of 224) of the cases, respectively. Significantly more errors occurred in the diagnosis of in situ and minimally invasive adenocarcinoma than in the diagnosis of invasive adenocarcinoma (P < .001). Frozen section errors and deferrals were twice as frequent in lesions smaller than 1.0 cm (P = .09). Features significantly associated with errors and deferrals included intraoperative consultation by more than one pathologist (P = .003) and more than one sample of frozen lung section (P = .001). Inflammation with reactive atypia, fibrosis/scar, sampling problems, and suboptimal quality sections were identified in 51.2% (21 of 41), 36.6% (15 of 41), 26.8% (11 of 41), and 9.8% (4 of 41) of the errors and deferrals, respectively (more than one of these factors was identified in some cases). Frozen section errors and deferrals had significant clinical impact in only 4 patients (1.8%); each had to undergo completion video-assisted thoracoscopic lobectomy less than 90 days after the initial surgery.

Conclusions.—The distinction of in situ from minimally invasive adenocarcinoma is difficult in both frozen and permanent sections. We identified several technical and interpretive features that likely contributed to frozen section errors and deferrals and suggest practice modifications that are likely to improve diagnostic accuracy.
A Unique, Histopathologic Lesion in a Subset of Patients With Spontaneous Pneumothorax
Authors: Belchis Deborah A. , Shekitka Kris , Gocke Christopher D.
Published: November 2012

Context.—Spontaneous pneumothorax can be idiopathic (primary), or it can occur in association with an underlying predisposing condition (secondary). Spontaneous pneumothorax may be a harbinger of an undiagnosed clinical condition, which may be associated with serious systemic abnormalities, making early recognition and diagnosis important. The pulmonary pathology of some of these disorders has not been fully elucidated.

Objective.—To review cases of pneumothorax in the hope of identifying pathologic features that might correlate to specific clinical syndromes.

Design.—The pathology computer files at 3 hospitals were searched for all cases of spontaneous pneumothorax, primary and secondary, regardless of etiology during a 11-year period. Ninety-two cases were retrieved. Each of the cases was evaluated for reactive eosinophilic pleuritis, elastosis, pleural fibrosis, emphysema, intra-alveolar macrophages, cholesterol clefts, vasculopathy, and intraparenchymal or intrapleural cysts. Clinical information regarding asthma and smoking history, site of the pneumothorax, family history, radiographic findings, predisposing conditions, recurrence, age, and sex were extracted from the medical records.

Results.—In 11 patients (12% of all the patients with spontaneous pneumothorax), a distinctive pattern of pleural fibrosis with islands of fibroblastic foci within a myxoid stroma was noted at the pleural-parenchymal interface or leading edge. These lesions correlated with a select subset of patients, consisting predominantly of young men.

Conclusions.—Our review identified a distinct pattern of pneumothorax–associated fibroblastic lesions in a subset of cases of spontaneous pneumothorax. Whether this is related to the pathogenesis of the pneumothorax remains to be elucidated.
Managing a Surface Water Supply to Meet Future Needs
Authors: Broome Kenneth , Cass Ronald , Waller Phil , Rojas Soli , Rice Amanda
Published: November 2012

This article discusses a project by Tampa Bay Water to expand the Tampa Bypass Canal Pump Station's capacity to improve the utility's surface water supply system. The project expanded the pump station's capacity from 138 mgd to 259 mgd and a repump station from 128 mgd to 185 mgd to collect and store water and supply the surface water treatment plant at a regional facility. The pump station withdraws available surface water from two segments of the bypass canal and transfers it to the repump station, which pumps the water to the reservoir or the surface water treatment plant. This article focuses on the bypass canal pump station, particularly site selection; operating conditions; expansion design, including capacity alternatives and intake screens; and construction.
Changing Public Perception About Water Purification
Authors: Steirer Marsi
Published: November 2012

This article discusses San Diego's well‐coordinated outreach efforts to help the public better understand the science behind and benefits of using purified water as part of a drinking water supply.
Comparison of APTIMA HPV E6/E7 mRNA and Hybrid Capture 2 Assays using Wet and Dry Self-Collected Flocked Vaginal Swabs and PreservCyt L-Pap Samples
Authors: L. Lawson  , A. Lytwyn  , D. Jang  , M. Howard  , L. Elit  , K. Onuma  , M. Klingel  , R. Toor  , J. Gilchrist  , A. Ecobichon-Morris  , M. Smieja  , M. Chernesky
Published: November 2012

Background: Performance of HPV assays on less invasive specimens can be assessed through agreement of assays and specimen types as well as the ability to identify patients with precancerous lesions. Objectives: To compare the APTIMA HPV (AHPV) E6/E7 mRNA assay to the HC2 DNA test for high risk (HR) HPV performed on PreservCyt L-Pap cervical specimens and flocked self-collected vaginal swabs (SCVS) transported to the laboratory wet or dry. Results: Testing specimens from 100 women attending a colposcopy clinic showed 90.7% (k=0.81) agreement between HC2 and AHPV assays for PreservCyt specimens. Agreement was 80.2% (K=0.80) to 88.0% (K=0.76) between L-Pap and wet and dry SCVS respectively and 89.2% (K=0.77) between the 2 SCVS by AHPV testing. For HC2, the agreement was 90.6% (k=0.81) to 89.2% (k=0.78) between L-Pap and the 2 swabs and 96.0% (k=0.90) between wet and dry swabs. Using pathology (CIN2+) as the reference standard, SCVS tested by AHPV demonstrated sensitivities of 88.8% for dry and 90% for wet SCVS, compared to 86.4% for L-Pap samples. HC2 testing of wet and dry SCVS was 70.8% sensitive compared to 94.4% for L-Pap samples. Conclusion: SCVS collected with flocked nylon swabs transported wet or dry may serve as alternative specimens for HPV testing of women who are reluctant to have a pelvic examination.
Imaging Analysis of Ameloblastoma of Mandible - 5 Cases
Authors: S. Jayachandran  , Khushboo Singh
Published: November 2012

Ameloblastoma is the most common odontogenic tumor of the jaws. It is seen in all age groups but the lesion is most commonly diagnosed in the third and fourth decades. It is often asymptomatic, presents as a slowly enlarging swelling or an incidental finding on a radiograph. Radiologically, usually appears as multilocular radiolucency with well defined and corticated borders but can also presents as unilocular radiolucency. Other radiological findings commonly associated are tooth displacement, and root resorption. Computed tomography (CT) shows cortical expansion and in some cases even cortical perforation. Ameloblastoma is a locally destructive tumor with a propensity for recurrence if not entirely excised. In this paper, we report 5 cases of ameloblastoma of mandible collected over the period of 8 months with various imaging findings and their analysis using panoramic radiograph under conventional radiography and CT scan under advanced imaging which may further aid in optimal treatment planning and outcome.
Tax Treatment of Security and Janitorial Service Agencies: An In-Depth Study
Authors: Malaya Christopher C.
Published: November 2012

Abstract - Security and janitorial service agencies are treated differently in terms of tax treatments. The study was to examine and analyze the similarities and differences of the treatments. It used both descriptive and analytical methods to uncover the factors that contributed to the preferential tax treatment of security agencies. The following significant findings were gathered from court decisions, journals, books, newspaper articles, and online publications and documents: (1) The security agency is given a preferential tax measures different from other service providers as shown from Revenue Memorandum Circular (RMC) No. 39-2007; (2) Congress of the Philippines is inclined to promote and provide a fair, efficient, and simple and transparent tax system; (3) Vested political and economic groups were lobbying hard in protecting their interests that allowed exemptions and uneven tax treatment; (4) Other business agencies are based on the same principles and business models of that of security agencies; and (5) No disparity of tax measures exists among service agencies in Singapore and United States. It concluded that the tax measures among service agencies were not applied fairly and equitably without any rational justification even they belong to the same business model. It also recommended that Revenue Memorandum Circular (RMC) No. 39-2007 should also be applicable to janitorial service agencies. Keywords - agencies, equity, janitorial agency, RMC 39-2007, security agency, service providers, and tax measures.
Studying Management Science: Difficulties and Ease of Students in the Philippines (The Case of St. Scholastica’s College Manila)
Authors: Sabio Ralph A.
Published: November 2012

Abstract - Management Science is concerned with developing and applying mathematical models and concepts that help to illuminate management issues and solve managerial problems. In most cases, it involves quantitative business analysis that is normally applied in operations management. Management Science or Quantitative Techniques in Business is one of the general education subjects under the Bachelor of Science in Business Administration (BSBA) course in the Philippine BSBA curriculum as prescribed by the Commission on Higher Education (CHED) under CHED Memorandum Order (CMO) 39 series of 2006. This paper will look into the difficulties and ease in taking Management Science as a general business education subject in BSBA course under the following six (6) majors: Business Information System Management, Business Management, International Business Economics and Diplomacy, Financial Management, Entrepreneurship and Franchise Management, and Marketing Management. The sample will be taken from the students taking Business Administration course at St. Scholastica’s College – Manila, enrolled during the first and second semester of SY2010-2012. Findings of this research may be useful in coming up with appropriate teaching/ learning methodologies and materials that aptly responds to student’s need. Further, the difficulties encountered by the student in studying Management Science subject will be properly addressed by providing a more learner-centered approach in teaching mathematical/quantitative business analysis, models and equations. Keywords - management science, quantitative business analysis, general business education, management, business administration
Corporate Governance Mechanism, Audit Quality and Accrual Quality (Indonesia Manufacturing Company Evidance)
Authors: Mukti Aloysius Harry , Wardhani Ratna
Published: November 2012

Abstract – This study examines the influence of implementation of corporate governance mechanism and audit quality toward accrual quality of the corporation. The implementation of corporate governance mechanism uses three measures: the effectiveness of the audit committee, board effectiveness and family ownership structure. For audit quality the measurements uses two approaches: amount of audit fee and grouping the company into two groups (audited by the auditor big-4 and audited by auditor non big-4). The study was conducted among selected manufacturing companies in Indonesia, during the period 2007-2009. Based on the results of the study, we find that only the board of Commissioners and grouping the company into two group (audited by the auditor big-4 and audited by auditor non big-4 experience) as a proxy of audit quality significantly improved quality of accrual. Keywords - Corporate governance mechanism, audit quality, accrual quality
Separate and Distinct: A Comparison of Scholarly Productivity, Teaching Load, and Compensation of Chiropractic Teaching Faculty to Other Sectors of Higher Education
Authors: Ward Robert W.
Published: November 2012

Background: Faculty scholarship, teaching load, and compensation can be indicators of institutional health and can impact curricular quality. Periodic data are published by the US Department of Education for all sectors of higher education, but do not list chiropractic colleges as a separate category. Objective: To report on the scholarly output, teaching load, and compensation of the full-time faculty at one chiropractic college, and to compare those data to national and local norms. Methods: Data on chiropractic faculty were collected from within the institution. External data were collected from the US Department of Education and US Bureau of Labor Statistics. Results: The chiropractic faculty assessed create about one-tenth the scholarly output, carried 2.7 times the course load of external doctoral faculty and 1.4 times the course load typical of 2-year (community) college faculty, received two-thirds the salary typical for all segments of education, and one-half the typical retirement benefits. Conclusion: Results are suggestive of significant deficiencies within chiropractic education that pose risk to the future of the profession. (The Journal of Chiropractic Education 21(1): 1–11, 2007)
Curriculum Reform in a Public Health Course at a Chiropractic College: Are We Making Progress Toward Improving Clinical Relevance?
Authors: Borody Cameron , Till Hettie
Published: November 2012

Improving education in health promotion and prevention has been identified as a priority for all accredited professional health care training programs, an issue recently addressed by a collaboration of stakeholders in chiropractic education who developed a model course outline for public health education. Using a course evaluation questionnaire, the authors surveyed students in the public health course at the Canadian Memorial Chiropractic College (CMCC) before and after the implementation of new course content based on the model course outline. Following the new course, there were significant improvements in perceived relevance to chiropractic practice and motivation to learn the material as a foundation for clinical practice. Changes made to the content and delivery of the course based on the model course outline were well received in the short term.
Business Training and Education Needs of Chiropractors
Authors: Henson Steve W , Pressley Milton , Korfmann Scott
Published: November 2012

Objective: This report is an examination of the perceived need for business skills among chiropractors. Methods: An online survey was completed by 64 chiropractors. They assessed the need for business skills and current levels of business skills. Using this information, gaps in business skills are identified. Results: The need for business skills is broad, encompassing all major business functions. Existing business skills are well below needed levels. Conclusion: The chiropractic profession needs significantly greater business and practice management skills. The existing gap between needed business skills and existing skills suggests that current training and education programs are not providing adequate business skills training.
Intentions of Chiropractic Interns Regarding use of Health Promotion in Practice: Applying Theory of Reasoned Action to Identify Attitudes, Beliefs, and Influencing Factors
Authors: Evans Marion W. , Ndetan Harrison , Williams Ronald D.
Published: November 2012

Purpose: The theory of reasoned action is a health behavioral theory that has been used to predict personal health behaviors and intentions as well as those of providers delivering health care. The purpose of this study was to determine interns' future practices regarding the use of health promotion using this model to develop survey questions and to determine attitudes and perceived influences on their prospective behaviors in general, toward the use of health promotion once in practice. Methods: Across the course of one year, all graduating interns at a chiropractic college were queried with a 20 question survey designed using the theory of reasoned action. Frequencies and inferential statistics were performed including prediction modeling using logistic regression. Results: A majority (>85%) of interns indicated they would use health promotion in practice. Differences were noted based on perceived skill levels, perception of educational emphasis, various normative beliefs, and gender. Conclusion: Most interns will use some form of health promotion in practice. Normative influences including those seen as key influencers are as powerful a predictor as perceived education or skill levels on future practice of health promotion.
Managing Conflicts of Interest in Continuing Medical Education: a Comparison of Policies
Authors: Lisi Anthony J.
Published: November 2012

Background: Altruism is a central underpinning of professional behavior; however physicians may face instances in which their secondary (financial) interest is in competition with their primary (patient health, research integrity, professional education) interests. Most medical institutions have developed policies to manage conflicts of interest, but chiropractic institutions, organizations and providersmay not be well-acquainted with such policies. Purpose: To compare the policies of the Department of Veterans Affairs (VA) and the North American Spine Society (NASS) regarding management of conflicts of interest in continuing medical education (CME). Methods: A qualitative review of published policies of the VA and NASS was performed. The policies of each organization were retrieved and reviewed, and data were entered into a spreadsheet for comparison. Content experts at each organization were contacted to provide additional information. Results: The VA and NASS provide explicit, similar policies to manage conflicts of interest in CME. Proposed speakers are required to disclose the nature and value of financial relationships relevant to content of their planned talk/presentation. Procedures for committee review, mitigation of conflict, or prohibiting the participation of a given speaker have been described. Disclosure must be made to the attendees of an educational activity in printed materials and at the time of presentation. Conclusion: The VA and NASS appear similar in their policies to manage conflicts of interest in CME. The policies of the VA and NASS may provide examples for the chiropractic profession to consider in relation to chiropractic continuing education.
Importance of Building Confidence in Patient Communication and Clinical Skills Among Chiropractic Students
Authors: Hecimovich Mark D. , Volet Simone E.
Published: November 2012

Purpose: One important objective of chiropractic education is to foster student professional confidence and competence in patient communication and clinical skills. Therefore, the aim of this article is to review the extant literature on this topic, stressing the significance of building students' confidence for effective practice and the need for more research in this area. Methods: The authors reviewed MEDLINE and ERIC from 1980 through 2008 using several key words pertinent to confidence and health care. Three distinct, but interrelated, bodies of literature were assessed, including professional confidence in health care research, the nature and development of confidence in educational psychology research, and fostering professional confidence in chiropractic education. Results: It was apparent through the review that chiropractic education has developed educational methods and opportunities that may help develop and build student confidence in patient communication and clinical skills. However, there has not been sufficient research to provide empirical evidence of the impact. Conclusion: Fostering chiropractic students' development of confidence in what they say and do is of paramount importance not only to them as new practitioners but more importantly to the patient. There is no doubt that a better understanding of how confidence can be developed and consolidated during tertiary study should be a major goal of chiropractic education.
Student-Generated Case Reports
Authors: Good Christopher J.
Published: November 2012

When students create teaching materials, learning can be enhanced. Therefore, a project was designed based on the traditional clinical case report and the chiropractic technique and principles curriculum at the University of Bridgeport College of Chiropractic. The objectives were to increase mastery in a clinical topic, increase awareness of different patient presentations and management options, and enhance information technology skills. Following lectures about the components of a case report and neurological reflexes related to visceral comorbidities and subluxation and joint dysfunction, students created a case report based on a template provided by the instructor. A survey gathered student perspectives on the exercise. More than 70% of the surveyed students felt the project was at least moderately helpful in improving understanding of a case report, the condition investigated, their clinical reasoning, and the ability to integrate information. Most felt that they improved their understanding of neurological reflexes, use of the literature, and the practice of evidence-based care. The majority believed that they identified weakness in knowledge, improved self-learning skills, and increased confidence in managing patients. Most enjoyed it at least somewhat and 70% agreed that the project should be continued. Many believed that they were better prepared for national boards and had improved their writing skills.
Diagnostic Imaging Guidelines Implementation Study for Spinal Disorders: A Randomized Trial with Postal Follow-ups*
Authors: Bussières André E. , Laurencelle Louis , Peterson Cynthia
Published: November 2012

Purpose: Implementation strategies of imaging guidelines can assist in reducing the number of radiographic examinations. This study aimed to compare the perceived need for diagnostic imaging before and after an educational intervention strategy. Methods: One hundred sixty Swiss chiropractors attending a conference were randomized to either receive a radiology workshop, reviewing appropriate indications for diagnostic imaging for adult spine disorders (n = 80), or be in a control group (CG). One group of 40 individuals dropped out from the CG due to logistic reasons. Participants in the intervention group were randomly assigned to three subgroups to evaluate the effect of an online reminder at midpoint. All participants underwent a pretest and a final test at 14–16 weeks. A posttest was administered to two subgroups at 8–10 weeks. Results: There was no difference between baseline scores, and overall scores for the pretest and the final tests for all four groups were not significantly different. However, the subgroup provided with access to a reminder performed significantly better than the subgroup with whom they were compared (F = 4.486; df = 1 and 30; p = .043). Guideline adherence was 50.5% (95% CI, 39.1–61.8) for the intervention group and 43.7% (95% CI, 23.7–63.6) for the CG at baseline. Adherence at follow-up was lower, but mean group differences remained insignificant. Conclusions: Online access to specific recommendations while making a clinical decision may favorably influence the intention to either order or not order imaging studies. However, a didactic presentation alone did not appear to change the perception for the need of diagnostic imaging studies.
Laboratory Pre-Participation Screening Examination in a Chiropractic College: Development, Implementation, and Results
Authors: Funk Matthew F. , Cantito Albert A.
Published: November 2012

Introduction: Chiropractic students often serve as subjects in laboratories where they and their classmates practice examinations, various soft tissue techniques, physiological therapeutic modalities, and active rehabilitation. There are contraindications and risks associated with these procedures. This article describes how a procedure was developed to identify potential health concerns and risks that students may face while serving as subjects or performing procedures in clinical skills laboratories. Methods: Screening questions and examination procedures were developed through a consensus process. Findings from the screening process determine whether students may engage in full participation or limited participation (precautions) or are prohibited from receiving certain procedures (contraindications). Skills laboratory students and their instructors are informed of any identifiable precautions or contraindications to participation. Results: Since its implementation, precautions regarding delivery of manual therapies were found in 4% of those examined and precautions regarding receiving manual therapies in 11.5%. Contraindications to receiving specified manual therapies were found in 8%, and 4% had contraindications to certain physiological therapeutic modalities. Discussion: Further work is necessary to improve compliance with follow-up regarding diagnosis of conditions revealed or suspected. Future efforts should address how well students adhered to precautions and contraindications, the nature and frequency of injuries sustained within the laboratories, and what specific measures were taken by faculty to help students with special needs. Conclusion: This chiropractic college now has a method to describe potential risks, explain rules of laboratory participation, and obtain consent from each student.
Are Patients Receiving Health Promotion Advice in the Chiropractic Teaching Clinic Setting?
Authors: Evans Marion Willard , Page Gregory , Ndetan Harrison , Martinez Daniel , Brandon Patricia , Daniel Dwain , Walker Clark
Published: November 2012

Purpose: The aim of this study was to analyze patient-reported health issues and levels of engagement, discussion of needed lifestyle changes, and goal setting with the patient's intern or staff doctor before and after a brief intervention to increase health-promoting activities in the clinic. Methods: Patient surveys were developed and administered to outpatients before and after a brief intervention aimed at increasing staff and intern engagement with patients on health promotion measures. Patients self-reported areas of need and levels of engagement by their doctor or intern. Data were analyzed as pre- and postintervention independent, cross-sectional samples. Frequencies and chi-square assessments were performed. Results: One hundred twenty-eight preintervention surveys and 162 postintervention surveys were collected. Back pain was the most common reason for being seen in the clinic (60% of patients) and most patients were white. More than 10% were smokers in both samples. Many patients reported poor diet, unhealthy weight, sleep issues, stress, or lack of regular physical activity, but 65% of the preintervention group and 72% of the postintervention group said a needed lifestyle change was discussed. Goals were set for 74% of the preintervention group and 84% of the postintervention group (p = .04). Information on lifestyle change was received by 52% of preintervention patients and 62% of postintervention patients and most were satisfied with this information. Goal setting was more common when a lifestyle change was discussed. Written information that was related to physical activity, for example, increased 350% (p < .0001). Conclusion: There are many opportunities for discussing needed lifestyle changes with patients. Patients self-report health behavioral issues related to physical activity, unhealthy weight, diet, stress, and sleep. More can be done in this area by this clinic, but initial assessments of impact from a brief intervention seem to have increased some levels of engagement by interns.
Depressive Symptoms in Chiropractic Students
Authors: Kinsinger Stuart , Puhl Aaron Anthony , Reinhart Christine J.
Published: November 2012

Background: The intensive training associated with health care education has been suggested to have unintended negative consequences on students' mental or emotional health that may interfere with the development of qualities deemed essential for proficient health care professionals. This longitudinal study examined the prevalence and severity of depressive symptoms among students at a chiropractic educational institution. Methods: Chiropractic students at all levels of training were surveyed at Canadian Memorial Chiropractic College during the academic years of 2000/2001, 2001/2002, and 2002/2003. The measurement tool employed was the Beck Depression Inventory, 2nd edition (BDI-II). Previously established BDI-II cutoff scores were used to assess the severity of reported depression symptoms, and these were compared by sex and year of training. Results: The survey was completed by 1303 students (70%) over the 3 years of the study. The prevalence of depressive symptoms was nearly 25%, with 13.7% of respondents indicating a rating of mild depression, 7.1% indicating moderate depressive symptoms, and 2.8% indicating severe symptoms. Significant differences were found between years of training, with 2nd-year students having the highest prevalence of depressive symptoms, and sex, with females having a higher rate of symptoms. Conclusions: Chiropractic students surveyed at Canadian Memorial Chiropractic College had high rates of depression similar to those measured in other health care profession students. Chiropractic educational institutions should be aware of this situation and are encouraged to emphasize students' awareness of their own personal health and well-being and their access to appropriate care, in addition to the same concerns for their future patients.
Allowing a Possible Margin of Error When Assessing Student Skills in Spinous Process Location
Authors: Hart John , Neely Cheneir
Published: November 2012

Introduction: Spinal palpation is subject to inconsistency between examiners. When testing students on the location of vertebral spinous processes, faculty examiners may wish to allow for a margin of error that is observed between experienced practitioners. This study attempts to determine such a margin of error for selected vertebral levels that could be allowed in testing situations at Sherman Chiropractic College. This could serve as a model for other chiropractic colleges in determining their margins of error. Methods: Two faculty clinicians palpated spinous processes at four different vertebral levels (C2, T3, T9, and L2) on 18 student volunteers. Differences for each vertebral level, along with one, two, and three standard deviations, were calculated. Results: Average differences between examiners increased caudally, as follows: C2, 4.23 ± 3.77 mm; T3, 13.41 ± 10.53 mm; T9, 18.17 ± 17.62 mm; L2, 18.70 ± 16.58 mm. Discussion: In this study, faculty examiners exhibited variation in their locations of spinous processes for these vertebrae. These variations could be allowed when assessing student skills in locating these spinous processes at this chiropractic college. Conclusion: In this study, differences between examiners plus or minus one standard deviation ranged from 4.23 ± 3.77 mm for C2 to 18.70 ± 16.58 mm for L2. The concept of margin of error should be considered by faculty examiners when assessing the skill of students in locating the spinous process of various vertebral levels.
Empowering Student Learning Through Rubric-Referenced Self-Assessment*
Authors: He Xiaohua , Canty Anne
Published: November 2012

Purpose: The purpose of this study was to investigate the effect of rubric-referenced self-assessment on performance of anatomy assignments in a group of chiropractic students. Methods: Participants (N = 259) were first-quarter students who were divided into a treatment group (n = 130) and a comparison group (n = 129). The intervention for both groups involved the use of rubrics to complete the first draft of assignments. General feedback was given by the instructor, and then the students had the opportunity to amend the assignments before resubmission (second draft). The treatment group, however, was also asked to perform rubric-referenced self-assessment of their assignments during their second draft. Although the comparison group was also provided with the identical rubrics for the assignments, the students in this group did not perform rubric-referenced self-assessment. Results: The results revealed that the students in the treatment group who used a rubric-referenced self-assessment learning tool received statistically significant higher scores than the comparison group, who did not use this rubric-referenced self-assessment tool. Conclusion: This study suggests that practicing rubric-referenced self-assessment enhances student performance on assignments. However, educators continue to face the challenge of developing practical and useful rubric tools for student self-assessment.
Formative Dialogues in Teaching
Authors: Rice Gail
Published: November 2012

Teaching universities, while claiming to value good teaching, do little to help individual faculty members improve learning in their classrooms. One effective way to help teachers reflect on their teaching and improve their teaching skills is to have a colleague observe and discuss the teaching episode, yet these dialogues seem to be rare. Visits to the classroom, if they occur at all, are usually summative, with little or no discussion, and typically used for the purposes of evaluation. The formative dialogues program, however, provides opportunities for faculty members to request a collegial, nonthreatening observation and discussion of a teaching session. The program is easy to administer and promises to provide opportunities to enhance the learning environment of the health professional classroom.
Demographic and Clinical Characteristics of New Patients Presenting to a Community Teaching Clinic
Authors: Lishchyna Natalia , Mior Silvano
Published: November 2012

Purpose: We compare patient populations attending chiropractors in the field to those in teaching clinics to allow educational institutions to determine if students are exposed to a similar case mix. The purpose of our study was to describe and compare descriptively the clinical case mix of a recently opened community-based teaching clinic to previously published practice data. Methods: A retrospective descriptive cross-sectional study was conducted using new patient records completed at a clinic. Data were extracted using a specifically designed abstraction form. Results: We manually abstracted 649 files. A total of 580 new patient files was included in the analysis, among which 57.7% included female patients with a mean age of 43 years (SD 18), and 42.1% presented with a chief complaint of more than one year in duration. The vast majority of patients complained of spinal pain (81.4%), most commonly low back pain. Almost 92% of the diagnoses were classified as simple (sprain/strain). The average number of visits per patient was 7.4 (SD 11.3); 54.7% received spinal manipulation on their first visit. The majority of patients were referred by the treating intern (64.8%) and about 24% of patients were local residents. Conclusions: Our study contributed to the few studies detailing patients attending chiropractic academic teaching clinics. It provided benchmark demographic and clinical data that may be used for operational planning. Our study suggested that the case mix of this teaching clinic provides interns with appropriate learning opportunities to achieve entry to practice competencies.