bluuebunny/crossref_metadata_2025 huggingface dataset:
A Serious Game for On-the-Ward Infection Control Awareness Training
Authors: Dunwell Ian , Jarvis Steve
Published: October 2014

Healthcare associated infections represent a major ongoing cost to health services. This chapter reviews the development and deployment of Ward Off Infection, a serious game targeted at improving infection control practices of nurses in on-the-ward training. The game was deployed in 2009 across 13 hospital wards within the UK. As limited usage of the game precluded attempts to consider its efficacy though pre and post-survey, this chapter focuses upon the key issues surrounding this low uptake. Relating these more generally to the deployment of serious games in healthcare, a potential link is observed between the presence of training professionals and usage of the game, as well as strong overriding perceptions of the medium and training objectives by users. The findings demonstrate the challenges associated with enacting effective behavioural and attitudinal change through a serious game deployed in an on the ward context, particularly with respect to stimulating high levels of perceived usefulness. Hence, the authors reflect on key lessons learned in the development and deployment of Ward Off Infection, and relate their findings to other studies of serious games in healthcare, identifying the context in which a game is deployed to be a critical development consideration.
Dimensions of Culture in Hospital Teamwork
Authors: Rosiek Anna , Leksowski Krzysztof
Published: October 2014

The chapter discusses, on research-based findings, the particularities of culture in hospitals, in a cross-cultural perspective with a particular focus on the Polish case. The findings of the study point to the fact that exterior factors and perceptions have a decisive impact on the patient evaluation of the hospital experience, so hospitals should dedicate some of their efforts to improving organizational culture and its perceived effects on patients.
Low Cost and Human-Centered Innovations in Healthcare Services
Authors: Padovani Emanuele , Orelli Rebecca L. , Agnoletti Vanni , Buccioli Matteo
Published: October 2014

This chapter focuses on a change effort for introduction of an e-governance innovation in the operating room management of a medium-sized Italian hospital, which led to higher levels of efficiency and effectiveness at once. The innovative project has made all the stages of the surgical process transparent, highlighting where there is an opportunity to improve overall performance via the introduction of organizational and process innovations. New techniques implemented and the specific factors that led to the hospital's success in achieving improved outcomes at lower costs are discussed. The chapter concludes by highlighting that low cost and human-centricity are amongst the key characteristics of success of this innovation.
Performance Studies of Integrated Network Scenarios in a Hospital Environment
Authors: Sarkar Nurul I. , Kuang Anita Xiao-min , Nisar Kashif , Amphawan Angela
Published: October 2014

Hospital network is evolving towards a more integrated approach by interconnecting wireless technologies into backbone networks. Although various integrated network scenarios have been published in the networking literature, a generic hospital model has not yet been fully explored and it remains a challenging topic in practice. One of the problems encountered by network practitioners is the seamless integration of network components into healthcare delivery. A good understanding of the performance of integrated networks is required for efficient design and deployment of such technologies in hospital environments. This research paper discuss on the modelling and evaluation of integrated network scenarios in hospital environments. The impact of traffic types (e.g. data, voice and video), traffic load, network size and signal strength on network performance is investigated by simulation. Three piloted case studies look at client performance in radiology Accident and Emergency (A & E and Intensive Care Unit (ICU)) scenarios. Each scenario reflects the need for various traffic types that end up distinct network behaviours. In the radiology scenario, email and File Transfer Protocol (FTP) traffic is found to perform well for medium-to-large networks. In the A & E scenario, Voice over Internet Protocol (VoIP) traffic is shown to generate very limited jitter and data loss. The performance is aligned with the Quality of Service (QoS) requirements. In the ICU scenario, the performance of video conference degrades with network size, thus, a QoS-enabled device is recommended to reduce the packet delay and data loss. IEEE 802.11a suits in hospital environment because it mitigates interference on the 2.4GHz band where most wireless devices operate.
Use of Barcodes to Improve Safety in Healthcare
Authors: So Hing-Yu
Published: October 2014

The application of barcode technology for verification, that is, confirming that the right procedure or medication is administered to the right patient, at the right time, can improve safety significantly in many healthcare processes. Details of applying barcodes in transfusion and medication administration are described to illustrate how they can help to reduce errors. However, the effectiveness of barcodes in error reduction relies on the compliance of staff. Workarounds – omission of steps, steps out of sequence, or unauthorized steps – can compromise patient safety. The technical, organizational, patient-related, and environmental factors, which encourage those practices, need to be understood to prevent their occurrence. Also, the introduction of barcodes can lead to a workflow change and increased workload, which may lead to adverse effects. Successful introduction of barcodes must take into account the design of the process, the change management, the human factors issues, as well as related organizational issues.
Grid Technology for Archive Solutions in Health Care Organizations
Authors: Previtali Pietro
Published: October 2014

The main aim of this chapter is to evaluate a Grid technology (GT) for Archive Solutions in terms of relevant features for Health Care Organizations (HCOs), and with particular attention to technical and organizational issues. The method used was a case study approach that was conducted during the months of March, April, and May 2011, applying a mix of random sampling (randomly selected interviewees from our directory) and “snowball” sampling (contacting interviewees through leads). The research shows that the introduction of grid technologies in HCOs maybe is still premature. However, a grid solution unquestionably led to some important benefits, so the author suggests a “progressive and gradual approach” to its implementation, aiming for further research on this topic.
Creating Connections across the PDS Network
Authors: Horn Suzanne
Published: October 2014

This chapter traces one professor's journey in a Professional Development School (PDS) network and her personal reflection on that journey. It showcases discoveries of the connections made between different participants of the network and how those connections are constructed in staff development, instruction, and conference presentations. Through the chapter a Common Core Vocabulary project is described and tracked as it is conceived in the elementary schools, then moved to the college classroom, then to the high school in the network, and then to the larger educational community. The chapter portrays how the ideas and activities in one PDS can impact multiple settings across the network and its many students.
Transformative Partnerships
Authors: Morewood Aimee L. , Taylor Susan E. , Hennen Linda
Published: October 2014

This chapter provides an overview of a Digital Stories project that was part of a Professional Development School partnership between a faculty member at a university and a nearby elementary school. Following a description of the project, the authors connect this project to reflective practice and different types of knowledge related to teaching.
Transformative Partnerships
Authors: Smaldino Sharon , Luetkehans Lara
Published: October 2014

With all higher education educational endeavors there is a transformative element that enhances the progression forward in terms of academic program development. Teacher education is no exception to this aspect of the evolutionary process. The authors' story of that transformation and the impact of creative endeavors in teacher education offer a sense of moving beyond the traditional to the transformative in teacher education. Carter (1993) offers that the story can offer a perspective on our work and inform teacher education on the directions we might take to bring about improvement in our efforts to prepare educators for the future. The authors' story begins with a strong foundation and commitment to understanding the critical elements of successful partnerships. This foundation has served them for 15 years, and two distinct eras of partnership work that delineate the transformation. The authors explore each era: “The Professional Development School (PDS) Story” followed by “10 Years Later.”
Designing Authentic Field-Based Experiences with Immigrant Students through One University and Urban School Partnership
Authors: Kolano Lan Quach , Childers-McKee Cherese
Published: October 2014

In an effort to create a meaningful clinical experience for undergraduate pre-service teachers, this chapter explores how authentic interactions with English Language Learners (ELLs) within university-school partnerships work to foster pre-service teachers' feelings of multicultural efficacy. Qualitative data were collected through reflective journals, case study projects, and archival data. Analysis of data from participants' reactions to the clinical experience suggests that multiple factors intersected to create a positive, authentic field experience for participants. Emergent themes included the impact of sociological mindfulness and the power of students' stories and lived experiences on shaping teacher beliefs. The data suggests that establishing a partner school with strong leadership that embraces diversity and supports ELLs and creating structured field experience in which participants engage in mentoring/tutoring relationships with ELLs is critical to this process. Implications for teacher educators and teacher education programs are discussed.
Sharing PDS Teacher Expertise with Pre-Service Teachers through Videos
Authors: Siebert Cathy J. , Wyss Vanessa L. , Jackson Tiffany
Published: October 2014

The true power of Professional Development School collaborations rests in the expertise and resources each partner brings to addressing challenges facing them. This chapter describes an initiative in which PDS high school partners and students collaborated with university partners to develop an informational DVD regarding Teacher Professionalism to be used with teacher candidates as part of their preparation program. The process followed and resources required to complete the project are described, perspectives of various parties involved are shared, and initial results of a pilot implementation in an undergraduate teacher education practicum sequence are discussed. Products such as the DVD described in this chapter provide avenues by which to share practitioner knowledge and expertise with pre-service teachers in rich and sustainable ways.
Leveraging a Professional Development School Project to Address Students' Learning in Elementary School Mathematics
Authors: Polly Drew
Published: October 2014

This chapter presents the partnership between a university faculty member and an elementary school that started to address students' learning needs regarding mathematics. This chapter provides: a) an overview of learner-centered professional development as a framework for this Professional Development School partnership, b) a description of the various professional development activities, c) and a summary of the impact of the project on instruction and student achievement. The chapter closes with recommendations for establishing and maintaining PDS partnerships focused on addressing students' learning needs.
The Necessity of Shared Vision to Achieve Coherence
Authors: Lynch-Davis Kathleen , Salinas Tracie M. , Crocker Deborah , Mawhinney Katherine J.
Published: October 2014

The adoption of Common Core State Standards for Mathematics (CCSSM) has implications for state-level curriculum, policy, and assessment. For most states, including North Carolina, the CCSSM represents a departure from recent state curricula and requires more than a simple “retooling” of content organization. To respond to such change, district and school-level leaders must share a common vision of high-quality mathematics teaching based on common understandings. Just as importantly, classroom teachers must share this vision. In this chapter, the authors describe the Appalachian Mathematics Partnership (AMP), the factors that have significant impact on partners, an activity, and how the understanding gained from this activity impacted future professional development with the goal of working towards a shared vision and coherence.
Viewing the Implementation of the CCSS through the Lens of One Transformative District-University Partnership
Authors: Lutz P. Michael
Published: October 2014

The study described in this chapter is on a more-than-20-year collaboration between a university mathematics department and its local high school district. The joint effort has created multiple components (such as strengthening teachers' mathematics knowledge, developing teacher leadership, and increasing teachers' appreciation of the importance of engaging students in tasks with a high cognitive demand) that are facilitating the districts' current efforts to implement the California Common Core State Standards for Mathematics. It describes a partnership that has always been grounded in mutual respect.
Unbounded Reading
Authors: Massey Dixie D.
Published: October 2014

Students' reading abilities and achievements are the focus of numerous national and international reports. At the same time, research on K-12 distance education offers a very limited description of the types of reading that students are asked to do or the students' abilities to accomplish this reading effectively. This chapter overviews the limited research about reading in online courses. The author then examines the potential of reading in online courses through bounded and unbounded contexts. The chapter concludes with instructional opportunities for teachers of online courses when designing reading assignments.
Synchronous Text Chat (EduTexting) as an Online Learning Tool
Authors: Heafner Tina L. , Plaisance Michelle
Published: October 2014

The increasing popularity and accessibility of affordable computer-mediated communication is rapidly changing the way in which we, as a society, interact and conduct business. This phenomenon is pervasive in all market sectors, including virtual K-12 education. This chapter examines collective and individual use of synchronous text chat to explore learner and instructor social and cognitive presence as well as their attitudes toward online learning. This mode of communication unilaterally enriches the observational learning experience for all participants. Overall, four meaningful social and cognitive functions of synchronous text chat in online learning contexts emerge: a) enhancing enjoyment, b) engagement and noticing, c) achieving community and providing interactive immediacy, and d) bridging of theory to practice. In the spirit of 21st century technological development, the authors coin this use of SMS (synchronous texting) in academic settings EduTexting. They argue for its application and appropriateness in K-12 online courses.
Establishing a Mentoring Relationship between Pre-Service and Mentor Teachers through Windows into Teaching and Learning
Authors: Petty Teresa , Heafner Tina L. , Farinde Abiola A. , Plaisance Michelle
Published: October 2014

Windows into Teaching and Learning (WiTL) was a project designed by researchers at one southeastern U.S. University that allowed the facilitation of online clinical experiences for graduate interns during their content area methods course. WiTL was originally developed to address challenges in providing meaningful clinical experiences for interns during online summer coursework. In providing these experiences, a mentoring relationship emerged between the participating practicing and pre-service teachers. This chapter explores those relationships and how they were fostered by the unique features of WiTL, which include online threaded discussions, synchronous and asynchronous viewings of classroom instruction, and text chat communication. These relationships are further supported through WiTL's debriefing process, which allows for immediate interaction between pre-service and mentor teachers. The type of dialogue and collaboration encouraged by WiTL results in strong mentoring relationships. The potential for programs like WiTL to be implemented in PK-12 settings are discussed.
High School Teachers' Gender-Oriented Perceptions of Technology Integration
Authors: Heafner Tina L. , Groce Eric , Bellows Elizabeth , Coffey Heather , Bjerre Mette Evelyn
Published: October 2014

Within social studies, researchers note limited attention has been given to examining gender differences associated with technology integration, and have called for increased dialogue regarding gender-related technology issues (Crocco, 2006, 2008; Crocco, Cramer, & Meier, 2008; Friedman & Hicks, 2006; Marri, 2007; Mason, Manfra, & Siko, 2005; Sanders, 2006). In response, this chapter explores the gender divide in secondary teachers' perceptions of effective technology integration. Using a qualitative research design, this chapter provides insight into social studies teachers' perceptions of their pedagogical practices and technology integration. The purpose of this study is to develop an understanding of the differences in male and female teachers' use of technology to teach and support student learning. Consideration of how technology is associated with gender-sensitive pedagogical thinking and practice may address the aforementioned gap in technology usage in social studies. Patterns uncovered in data analysis suggest that gender plays a critical role in social studies technology integration. The results from this study can inform methods in which technology is integrated into future social studies classrooms, particularly in emerging areas such as online courses.
Differential Efficacy of Human Mesenchymal Stem Cells Based on Source of Origin
Authors: Collins Erin , Gu Fei , Qi Maosong , Molano Ivan , Ruiz Phillip , Sun Lingyun , Gilkeson Gary S.
Published: October 2014

Mesenchymal stem cells (MSCs) are useful in tissue repair but also possess immunomodulatory properties. Murine and uncontrolled human trials suggest efficacy of MSCs in treating lupus. Autologous cells are preferable; however, recent studies suggest that lupus-derived MSCs lack efficacy in treating disease. Thus, the optimum derivation of MSCs for use in lupus is unknown. It is also unknown which in vitro assays of MSC function predict in vivo efficacy. The objectives for this study were to provide insight into the optimum source of MSCs and to identify in vitro assays that predict in vivo efficacy. We derived MSCs from four umbilical cords, four healthy bone marrows (BMs), and four lupus BMs. In diseased MRL/lpr mice, MSCs from healthy BM and umbilical cords significantly decreased renal disease, whereas lupus BM MSCs only delayed disease. Current in vitro assays did not differentiate efficacy of the different MSCs. However, differences in MSC efficacy were observed in B cell proliferation assays. Our results suggest that autologous MSCs from lupus patients are not effective in treating disease. Furthermore, standard in vitro assays for MSC licensing are not predictive of in vivo efficacy, whereas inhibiting B cell proliferation appears to differentiate effective MSCs from ineffective MSCs.
Dynamic thermal simulation on retrofitting scenarios for semi-extensive sheep farms
Authors: Menconi Maria E. , Grohmann David , Borghi Piero
Published: October 2014

Sheep and goat have a high adaptability to different climatic conditions. Nevertheless, even in extensive farming, these species benefit from the presence of structures that can mitigate stress from heat, cold and humidity changes. These shelters are used at night or for limited periods during the year. These are characterised by a low engineering and make extensive use of recycled material. Interesting innovation in rural areas could be represented by the re-development of these buildings in order to improve their internal microclimate. This work develops a thermal dynamic simulation model aimed at identifying the best solution to retrofit the envelope of existing livestock buildings. In this paper, three different solutions have been tested: insulation of vertical surfaces, insulation of roof and window type. Eight different materials have been considered for roof and vertical surfaces and four for the different kind of window glazing, analysing the building microclimate responses. As a reference building to compare the different solutions adopted has been chosen an extensive sheep farm located in the Italian Apennines. The results suggest that the best solution is to insulate the roof. The other elements offer negligible results in term of improving the internal microclimate conditions. For coating the roof it can also be considered a good response of all the analysed insulating materials, in order to increase the period of maintaining the temperature of comfort and not exceeding its critical values within the building.
Calvin on Human Reason
Authors: Vorster Nicolaas
Published: October 2014

In his recent book The Unintended Reformation, Brad Gregory makes the statement that the Reformation replaced the teleological social ethics of Roman Catholicism based on virtue with formal social ethics based on rules and enforced by magistrates, because they regarded human reason as too depraved to acquire virtue. The result, according to Gregory, is that the relation between internalised values and rules were undermined. This article asks whether this accusation is true with regard to Calvin. The first section discusses the intellectual environment of Calvin’s day – something that inevitably influenced his theory on reason, whilst the second part analyses Calvin’s view on the created nature of reason. The third section investigates Calvin’s view on the effects of sin on reason; and the fourth section discusses Calvin’s perspective on the relation between grace and reason. The article concludes that Gregory’s accusation against the Reformation is not applicable to Calvin. Gregory fails to take into account Calvin’s modified position that the imago Dei was not totally destroyed by sin as well as his teaching on common grace that maintains that even non-believers are able to acquire virtue through the common grace of God.Calvyn oor Menslike Rede. In sy onlangse boek, The Unintended Reformation, maak Brad Gregory die stelling dat die Reformasie die substantiewe teleologiese deugde-etiek van die Rooms-Katolisisme vervang het met ‘n formele etiek gebaseer op reëls wat deur magistrate afgedwing moet word. Die Reformasie was, volgens Gregory, van mening dat die menslike rede sodanig deur sonde geskend is dat die mens nie langer deugde kan beoefen nie. Dit het tot ‘n skadelike skeiding tussen waardes en reëls gelei. Hierdie artikel ondersoek die vraag of Gregory se stelling op Calvyn van toepassing is. Die eerste afdeling bespreek die intellektuele omgewing waarin Calvyn gewerk het. Tweedens word Gregory se siening van die geskape struktuur van die rede bespreek. Die derde afdeling ondersoek Calvyn se siening oor die effek van sonde op die menslike rede; en in die vierde afdeling word daar gekyk na Calvyn se perspektief op die verhouding tussen genade en rede. Die artikel kom tot die slotsom dat Gregory se bewering nie op Calvyn van toepassing gemaak kan word nie. Gregory neem verkeerdelik aan dat Calvyn die siening handhaaf dat die mens se beeldskap heeltemal deur die sonde vernietig is. Hy verreken geensins Calvyn se doktrine oor God se algemene genade nie. Hierdie doktrine stel onder meer dat God se algemene genade dit vir alle mense moontlik maak om deugde te beoefen.
Subgroups approximatively of finite index and wreath products
Authors: Cornulier Yves
Published: October 2014

In a group,we introduce a notion of subgroup approximatively of finite index, which extends the notion of groups approximable by finite groups. We deduce a characterization of (restricted, permutational) wreath products that are approximable by finite groups.
Burnout and Physical Activity in Minnesota Internal Medicine Resident Physicians
Authors: Olson Shawn M. , Odo Nnaemeka U. , Duran Alisa M. , Pereira Anne G. , Mandel Jeffrey H.
Published: October 2014

Background

Regular physical activity plays an important role in the amelioration of several mental health disorders; however, its relationship with burnout has not yet been clarified.

Objective

To determine the association between achievement of national physical activity guidelines and burnout in internal medicine resident physicians.

Methods

A Web-based survey of internal medicine resident physicians at the University of Minnesota and Hennepin County Medical Center was conducted from September to October 2012. Survey measures included the Maslach Burnout Inventory-Human Services Survey and the International Physical Activity Questionnaire.

Results

Of 149 eligible residents, 76 (51.0%) completed surveys, which were used in the analysis. Burnout prevalence, determined by the Maslach Burnout Inventory, was 53.9% (41 of 76). Prevalence of failure to achieve US Department of Health and Human Services physical activity guidelines was 40.8% (31 of 76), and 78.9% (60 of 76) of residents reported that their level of physical activity has decreased since they began medical training. Residents who were able to meet physical activity guidelines were less likely to be burned out than their fellow residents (OR, 0.38, 95% CI 0.147–0.99).

Conclusions

Among internal medicine resident physicians, achievement of national physical activity guidelines appears to be inversely associated with burnout. Given the high national prevalence of burnout and inactivity, additional investigation of this relationship appears warranted.
What Makes a Great Resident Teacher? A Multicenter Survey of Medical Students Attending an Internal Medicine Conference
Authors: Melvin Lindsay , Kassam Zain , Burke Andrew , Wasi Parveen , Neary John
Published: October 2014

Background

Residents have a critical role in the education of medical students and have a unique teaching relationship because of their close proximity in professional development and opportunities for direct supervision. Although there is emerging literature on ways to prepare residents to be effective teachers, there is a paucity of data on what medical students believe are the attributes of successful resident teachers.

Objective

We sought to define the qualities and teaching techniques that learners interested in internal medicine value in resident teachers.

Methods

We created and administered a resident-as-teacher traits survey to senior medical students from 6 medical schools attending a resident-facilitated clinical conference at McMaster University. The survey collected data on student preferences of techniques employed by resident teachers and qualities of a successful resident teacher.

Results

Of 90 student participants, 80 (89%) responded. Respondents found the use of clinical examples (78%, 62 of 80) and repetition of core concepts (71%, 58 of 80) highly useful. In contrast, most respondents did not perceive giving feedback to residents, or receiving feedback from residents, was useful to their learning. With respect to resident qualities, respondents felt that a strong knowledge base (80%, 64 of 80) and tailoring teaching to the learner's level (83%, 66 of 80) was highly important. In contrast, high expectations on the part of resident supervisors were not valued.

Conclusions

This multicenter survey provides insight into the perceptions of medical students interested in internal medicine on the techniques and qualities that characterize successful resident teachers. The findings may be useful in the future development of resident-as-teacher curricula.
Restoring Emphasis on Ambulatory Internal Medicine Training—The 3∶1 Model
Authors: Harrison Joshua W. , Ramaiya Astha , Cronkright Peter
Published: October 2014

Background

Resident dissatisfaction in ambulatory care training has prompted the need for new scheduling models that support a positive learning climate.

Intervention

We instituted a 3∶1 scheduling model for postgraduate year (PGY)–2 and PGY-3 residents. We hypothesized this model would provide a more structured ambulatory educational atmosphere, better continuity of care, and more exposure to subspecialty outpatient medicine. This model would also eliminate conflict with inpatient duties and contribute to enhance residents′ satisfaction with ambulatory medicine and their ambulatory education experience. The model used weeklong ambulatory blocks every fourth week, consisting of morning continuity clinic and afternoon subspecialty clinics. The PGY-1 residents maintained a traditional schedule.

Results

Residents were surveyed regarding their ambulatory experience, with an overall response rate of 73 of 80 (91%). The PGY-2 and PGY-3 responses were analyzed descriptively and compared with PGY-1 responses. Residents reported that the 3∶1 model positively affected their satisfaction with residency training in general, their satisfaction with outpatient/primary care training, and their outpatient/clinic educational experience. Residents in the 3∶1 model perceived improvements in continuity of care and in the quality of care they provided for patients. The experience in ambulatory subspecialty training was positive.

Conclusions

A 3∶1 scheduling model appears to mitigate some of the conflict between inpatient and outpatient duties. Residents agreed the new model promoted an improved ambulatory experience.
Exploring Clinical Reasoning Strategies and Test-Taking Behaviors During Clinical Vignette Style Multiple-Choice Examinations: A Mixed Methods Study
Authors: Heist Brian Sanjay , Gonzalo Jed David , Durning Steven , Torre Dario , Elnicki David Michael
Published: October 2014

Background

Clinical vignette multiple-choice questions (MCQs) are widely used in medical education, but clinical reasoning (CR) strategies employed when approaching these questions have not been well described.

Objectives

The aims of the study were (1) to identify CR strategies and test-taking (TT) behaviors of physician trainees while solving clinical vignette MCQs; and (2) to examine the relationships between CR strategies and behaviors, and performance on a high-stakes clinical vignette MCQ examination.

Methods

Thirteen postgraduate year–1 level trainees completed 6 clinical vignette MCQs using a think-aloud protocol. Thematic analysis employing elements of grounded theory was performed on data transcriptions to identify CR strategies and TT behaviors. Participants' CR strategies and TT behaviors were then compared with their US Medical Licensing Examination Step 2 Clinical Knowledge scores.

Results

Twelve CR strategies and TT behaviors were identified. Individuals with low performance on Step 2 Clinical Knowledge demonstrated increased premature closure and increased faulty knowledge, and showed comparatively less ruling out of alternatives or admission of knowledge deficits. High performers on Step 2 Clinical Knowledge demonstrated increased ruling out of alternatives and admission of knowledge deficits, and less premature closure, faulty knowledge, or closure prior to reading the alternatives.

Conclusions

Different patterns of CR strategies and TT behaviors may be used by high and low performers during high-stakes clinical vignette MCQ examinations.
A Clinical Process Change and Educational Intervention to Reduce the Use of Unnecessary Preoperative Tests
Authors: Richards Sarah E. , Shiffermiller Jason F. , Wells Adam D. , May Sara M. , Chakraborty Subhankar , Caverzagie Kelly J. , Beachy Micah W.
Published: October 2014

Background

Internal medicine residents receive limited training on how to be good stewards of health care dollars while preserving high-quality care.

Intervention

We implemented a clinical process change and an educational intervention focused on the appropriate use of preoperative diagnostic testing by residents at a Veterans Administration (VA) medical center.

Methods

The clinical process change consisted of reducing routine ordering of preoperative tests in the absence of specific indications. Residents received a short didactic session, which included algorithms for determining the appropriate use of perioperative diagnostic testing. One outcome was the average cost savings on preoperative testing for a continuous cohort of patients referred for elective knee or hip surgery. Resident knowledge and confidence prior to and after the intervention was measured by pre- and posttest.

Results

The mean cost of preoperative testing decreased from $74 to $28 per patient after the dual intervention (P < .001). The bulk of cost savings came from elimination of unnecessary blood and urine tests, as well as reduced numbers of electrocardiograms and chest radiographs. Among residents who completed the pretest and posttest, the mean score on the pretest was 54%, compared with 80% on the posttest (P  =  .027). Following the educational intervention, 70% of residents stated they felt “very comfortable” ordering appropriate preoperative testing (P  =  .006).

Conclusions

This initiative required few resources, and it simultaneously improved the educational experience for residents and reduced costs. Other institutions may be able to adopt or adapt this intervention to reduce unnecessary diagnostic expenditures.
Survey of Residents' Attitudes and Awareness Toward Teaching and Student Feedback
Authors: Tuck Keiran K. , Murchison Charles , Flores Christine , Kraakevik Jeff
Published: October 2014

Background

Teaching medical students is an important component of residency; however, little is known about student feedback regarding resident teaching skills.

Objective

We sought to explore resident awareness of medical student feedback mechanisms and how feedback is obtained, and also identified attitudes about teaching more commonly found in residents who seek feedback.

Methods

We surveyed all resident physicians at a university-affiliated academic health center about awareness of student feedback regarding their teaching abilities, and their attitudes related to teaching that may impact whether residents seek feedback.

Results

Of 605 residents, 335 (55%) responded, with 72% (242 of 335) noting they did not formally review student feedback of their teaching with their advisor during regularly scheduled meetings, 42% (140 of 332) reporting they did not know of any formal feedback mechanisms, and 28.4% (95 of 334) reporting they had not received feedback from students in any format. Although only a quarter of residents solicit feedback always or often, more than half would like feedback always or often. Reported barriers to feedback included student apprehension, time constraints, and lack of a formal system. A majority of residents had positive attitudes toward teaching and felt that student feedback would help teaching ability and medical proficiency.

Conclusions

A large percentage of residents at 1 teaching institution reported not receiving feedback from students on their teaching abilities. Residents who did receive feedback were more likely to have actively solicited it. Overall, residents believe that this feedback from students would benefit their clinical and teaching performance.
Thermal-based modeling of coupled carbon, water and energy fluxes using nominal light use efficiencies constrained by leaf chlorophyll observations
Authors: Schull M. A. , Anderson M. C. , Houborg R. , Gitelson A. , Kustas W. P.
Published: October 2014

Abstract. Recent studies have shown that estimates of leaf chlorophyll content (Chl), defined as the combined mass of chlorophyll a and chlorophyll b per unit leaf area, can be useful for constraining estimates of canopy light-use-efficiency (LUE). Canopy LUE describes the amount of carbon assimilated by a vegetative canopy for a given amount of Absorbed Photosynthetically Active Radiation (APAR) and is a key parameter for modeling land-surface carbon fluxes. A carbon-enabled version of the remote sensing-based Two-Source Energy Balance (TSEB) model simulates coupled canopy transpiration and carbon assimilation using an analytical sub-model of canopy resistance constrained by inputs of nominal LUE (βn), which is modulated within the model in response to varying conditions in light, humidity, ambient CO2 concentration and temperature. Soil moisture constraints on water and carbon exchange are conveyed to the TSEB-LUE indirectly through thermal infrared measurements of land-surface temperature. We investigate the capability of using Chl estimates for capturing seasonal trends in the canopy βn from in situ measurements of Chl acquired in irrigated and rain-fed fields of soybean and maize near Mead, Nebraska. The results show that field-measured Chl is non-linearly related to βn, with variability primarily related to phenological changes during early growth and senescence. Utilizing seasonally varying βn inputs based on an empirical relationship with in-situ measured Chl resulted in improvements in carbon flux estimates from the TSEB model, while adjusting the partitioning of total water loss between plant transpiration and soil evaporation. The observed Chl-βn relationship provides a functional mechanism for integrating remotely sensed Chl into the TSEB model, with the potential for improved mapping of coupled carbon, water, and energy fluxes across vegetated landscapes.
Seasonal survey of the composition and degradation state of particulate organic matter in the Rhone River using lipid tracers
Authors: Galeron M.-A. , Amiraux R. , Charriere B. , Radakovitch O. , Raimbault P. , Garcia N. , Lagadec V. , Vaultier F. , Rontani J.-F.
Published: October 2014

Abstract. Lipid tracers including fatty acids, hydroxyacids, n-alkanols, sterols and triterpenoids were used to determine the origin and fate of suspended particulate organic matter (POM) collected in the Rhone River (France). This seasonal survey (April 2011 to May 2013) revealed a year-round strong terrigenous contribution to the plant-derived particulate organic matter (POM), with significant algal inputs observed in March and attributed to phytoplanktonic blooms likely dominated by diatoms. Major terrigenous contributors to our samples are gymnosperms, and more precisely their roots and stems, as evidenced by the presence of high proportions of ω-hydroxydocosanoic acid (a suberin biomarker). The high amounts of coprostanol detected clearly show that the Rhone River is significantly affected by sewage waters. Specific sterol degradation products were quantified and used to assess the part of biotic and abiotic degradation of POM within the river. Plant-derived organic matter appears to be mainly affected by photo-oxidation and autoxidation (free radical oxidation), while organic matter of human origin, evidenced by the presence of coprostanol, is clearly more prone to bacterial degradation. Despite the involvement of an intense autoxidation-inducing homolytic cleavage of peroxy bonds, a significant proportion of hydroperoxides is still intact in higher plant debris. These compounds could affect the degradation of terrestrial material by inducing an intense autoxidation upon its arrival at sea.
A twelve-year high-resolution climatology of atmospheric water transport on the Tibetan Plateau
Authors: Curio J. , Maussion F. , Scherer D.
Published: October 2014

Abstract. The Tibetan Plateau (TP) plays a key role in the water cycle of High Asia and its downstream regions. The respective influence of the Indian and East Asian summer monsoon on TP precipitation and the regional water resources, together with the detection of moisture transport pathways and source regions are subject of recent research. In this study we present a twelve-year high-resolution climatology of the atmospheric water transport (AWT) on and towards the TP, using a new dataset, the High Asia Reanalysis (HAR), which better represents the complex topography of the TP and surrounding high mountain ranges than coarse resolution datasets. We focus on spatio-temporal patterns, vertical distribution and transport through the TP boundaries. The results show that the mid-latitude westerlies have a higher share in summertime AWT on the TP than assumed so far. Water vapour (WV) transport constitute the main part, whereby transports of water as cloud particles (CP) play also a role in winter in the Karakoram and western Himalayan regions. High mountain valleys in the Himalayas facilitate AWT from the south whereas the high mountain regions inhibit the AWT to a large extend and limit the influence of the Indian summer monsoon. No transport from the East Asian monsoon to the TP could be detected. Our results show that 40% of the atmospheric moisture needed for precipitation comes from outside the TP, while the remaining 60% are provided by local moisture recycling. How far precipitation variability can be explained by variable moisture supply has to be studied in future research by analysing the atmospheric dynamic and moisture recycling more in detail.
Air quality forecast of PM10 in Beijing with Community Multi-scale Air Quality Modeling (CMAQ) system: emission and improvement
Authors: Wu Q. Z. , Xu W. S. , Shi A. J. , Li Y. T. , Zhao X. J. , Wang Z. F. , Li J. X. , Wang L. N.
Published: October 2014

Abstract. The MM5-SMOKE-CMAQ model system, which was developed by the United States Environmental Protection Agency (US EPA) as the MODELS-3 system, has been used for daily air quality forecasts in the Beijing Municipal Environmental Monitoring Center (Beijing MEMC), as a part of the Ensemble air quality Modeling forecast System for Beijing (EMS-Beijing) since the 2008 Olympic Games. According to the daily forecast results for the entire duration of 2010, the model shows good performance in the PM10 forecast on most days but clearly underestimates PM10 concentration during some air pollution episodes. A typical air pollution episode from 11–20 January 2010 was chosen, in which the observed air pollution index of particulate matter (PM10-API) reached 180 while the forecast PM10-API was about 100. In this study, three numerical methods are used for model improvement: first, by enhancing the inner domain with 3 km resolution grids, and expanding the coverage from only Beijing to an area including Beijing and its surrounding cities; second, by adding more regional point source emissions located at Baoding, Landfang and Tangshan, to the south and east of Beijing; third, by updating the area source emissions, including the regional area source emissions in Baoding and Tangshan and the local village/town-level area source emissions in Beijing. The last two methods are combined as the updated emissions method. According to the model sensitivity testing results by the CMAQ model, the updated emissions method and expanded model domain method can both improve the model performance separately. But the expanded model domain method has better ability to capture the peak values of PM10 than the updated emissions method due to better reproduction of the pollution transport process in this episode. As a result, the hindcast results ("New(CMAQ)"), which are driven by the updated emissions in the expanded model domain, show a much better model performance in the national standard station-averaged PM10-API. The daily hindcast PM10-API reaches 180 and is much closer to the observed value, and has a high correlation coefficient of 0.93. The correlation coefficient of the PM10-API in all Beijing MEMC stations between the hindcast and observation is 0.82, clearly higher than the forecast 0.54. The FAC2 increases from 56% in the forecast to 84% in the hindcast, and the NMSE decreases from 0.886 to 0.196. The hindcast also has better model performance in PM10 hourly concentrations during the typical air pollution episode. The updated emissions method accompanied by a suitable domain in this study improved the model performance for the Beijing area significantly.
Hindcast regional climate simulations within EURO-CORDEX: evaluation of a WRF multi-physics ensemble
Authors: Katragkou E. , García-Díez M. , Vautard R. , Sobolowski S. , Zanis P. , Alexandri G. , Cardoso R. M. , Colette A. , Fernández J. , Gobiet A. , Goergen K. , Karacostas T. , Knist S. , Mayer S. , Soares P. M. M. , Pytharoulis I. , Tegoulias I. , Tsikerdekis A. , Jacob D.
Published: October 2014

Abstract. In the current work we present six hindcast Weather Research and Forecasting (WRF) simulations for the EURO-CORDEX domain with different configurations in microphysics, convection and radiation for the time period 1990–2008. All regional model simulations are forced by the ERA-Interim reanalysis and have the same spatial resolution (0.44°). These simulations are evaluated for surface temperature, precipitation, short- and longwave downward radiation at the surface and total cloud cover. The analysis of the WRF ensemble indicates systematic biases in both temperature and precipitation linked to different physical mechanisms for the summer and winter season. Overestimation of total cloud cover and underestimation of downward shortwave radiation at the surface, mostly when using Grell–Devenyi convection and the CAM radiation scheme, intensifies the negative summer temperature bias in northern Europe (max −2.5 °C). Conversely, a strong positive downward shortwave summer bias in central (40–60%) and southern Europe mitigates the systematic cold bias in WRF over these regions, signifying a typical case of error compensation. Maximum winter cold bias is over north-eastern Europe (−2.8 °C); this location is indicative of land–atmosphere rather than cloud-radiation interactions. Precipitation is systematically overestimated in summer by all model configurations, especially the higher quantiles, which are associated with summertime deep cumulus convection. The Kain–Fritsch convection scheme produces the larger summertime precipitation biases over the Mediterranean. Winter precipitation is reproduced with lower biases by all model configurations (15–30%). The results of this study indicate the importance of evaluating not only the basic climatic parameters of interest for climate change applications (temperature-precipitation), but also other components of the energy and water cycle, in order to identify the sources of systematic biases, possible compensatory or masking mechanisms and suggest methodologies for model improvement.