bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of substituting corn with steam-flaked sorghum on growth, digestion and blood metabolites in young cattle fed feedlot diets
Authors: Wang C. , Liu Q. , Guo G. , Huo W. J. , Zhang Y. L. , Pei C. X. , Zhang S. L. , Yang W. Z. , Wang H.
Published: September 2016

The objective of the present study was to evaluate the effects of substituting ground corn grain with steam-flaked sorghum (SFS) grain on growth performance, nutrient utilisation and blood metabolites in beef bulls. Fifty-six Simmental beef bulls averaging 12 months of age and 356.4 ± 2.6 kg of bodyweight were randomly assigned to four groups. The treatments were control, low-SFS, medium-SFS and high–SFS, with 0, 1/3, 2/3 and 3/3 SFS grain, respectively, substituting ground corn grain of diets(dry matter (DM) basis). Diets consisted of 50% corn silage and 50% concentrate (DM basis). The average daily gain and feed conversion rate improved quadratically with increasing the proportion of SFS grain. Ruminal pH and ammonia-nitrogen (N) concentration decreased quadratically, whereas ruminal total volatile fatty acid concentration increased quadratically. Ratio of acetate to propionate decreased quadratically (P = 0.027) due to the quadratic decrease in acetate production and the quadratic increase in propionate production. Digestibilities of DM, organic matter and crude protein increased quadratically, whereas that of neutral detergent fibre and acid detergent fibre decreased quadratically. The digestible N, retention N and the retention N to digestible N ratio improved quadratically. Inclusion of SFS grain in diets quadratically increased blood concentrations of glucose, total protein, albumin and triglyceride, but quadratically decreased the concentration of urea N. The results indicated that partly substituting ground corn grain with SFS grain could improve growth performance by improving ruminal fermentation and N utilisation; the optimum substitution rate was 2/3 (DM basis).
Age validation of the blue shark (Prionace glauca) in the eastern Pacific Ocean
Authors: Wells R. J. David , Spear Natalie , Kohin Suzanne
Published: September 2016

The blue shark (Prionace glauca) is subjected to high levels of fishery catch and by-catch worldwide; thus, knowledge of their productivity and population status is vital, yet basic assumptions of band-pair deposition rates in vertebrae used for age and growth models are being made without direct validation studies in the Pacific Ocean. As such, the purpose of the present study was to validate vertebral band-deposition rates of blue sharks tagged and recaptured in the eastern Pacific Ocean. Vertebrae of 26 blue sharks marked with oxytetracycline (OTC) were obtained from tag–recapture activities to determine timing of centrum growth-band deposition. Results from band counts distal to the OTC mark on each vertebra indicated that a single band pair (1 translucent and 1 opaque) is formed per year for blue sharks ranging from 1 to 8 years of age. Length–frequency modal analysis was also used to obtain growth estimates from a dataset spanning 26 years of research and commercial catch data. Results provide support for annual band-pair deposition in blue shark vertebrae and will aid in future blue shark age and growth studies in the Pacific Ocean.
Role of polyamines in abiotic stress responses.
Authors: Merewitz E.
Published: September 2016

Many secondary metabolites in plants are involved in a range of plant physiological processes including abiotic stress tolerance. Major polyamine (PA) compounds including putrescine (Put), spermidine (Spd) and spermine (Spm) have structural, functional and regulatory activities that allow them to play a major role in abiotic stress tolerance. A thorough understanding of PA function in plant stress tolerance is important for improving plant stress responses, breeding, biomarker development and other purposes. In this review, I discuss the role of PA in several types of abiotic stress and the mechanisms associated with dynamic changes in PA content. Major methods to evaluate PA function are discussed including biosynthetic gene expression, exogenous application of PA, use of PA biosynthesis inhibitors, transgenic manipulation and development of gain or loss of function mutants.
Bivariate relationships incorporating method comparison: a review of linear regression methods.
Authors: Dhanoa M. S. , Sanderson R. , López S. , France J.
Published: September 2016

In this review, we describe and illustrate the selection and use of some appropriate regression models for bivariate statistical relationships. The most commonly used method, ordinary least squares (OLS) or type I regression, may be inappropriate when the predictor variable is subject to measurement errors since this violates a fundamental assumption of OLS and as a result estimates of slope are likely to be biased or attenuated. The
y
-axis intercept will be biased too as it is a function of slope estimate and the means of
y
- and
x
-variables. This bias can have some undesirable consequences if OLS regression parameters and/or functions of them are used further with meaningful interpretations. For example, in animal energy balance studies, slope estimate represents efficiency of metabolizable energy utilization for body mass growth or milk production in dairy cows. The
x
-axis intercept, a function of
y
-intercept and slope, gives an estimate of the animal's body mass maintenance energy requirement. The choice of an alternative type II or functional regression model (e.g. maximum likelihood solution, major axis, reduced major axis and others) depends on the availability and ratio of measurement or precision variances of both
y
- and
x
-variables; otherwise non-parametric models (e.g. Theil-Sen non-parametric regression or Bartlett's three-group method) can be used. When the ratio of
y
- and
x
-variable error variances is not constant over the data range then the reiterated weighted functional model as described by Ripley and Thompson in 1987 may be necessary. Application of these models and other tests (e.g. mean-square prediction error, analysis of concordance) in analytical method comparisons is outlined. Data scrutiny and outlier diagnostics are included because outliers affect most of the non-robust statistics.
Comparative analysis of Physics master degree curricula across national and institutional settings: manifestations of student‐centred learning and implications for degree comparability
Authors: Sin Cristina
Published: September 2016

The paper examines comparatively the curricula of six Physics MSc degrees from three countries (England, Portugal and Denmark) in the European policy context driven by the Bologna Process, which advocates degree comparability and student‐centred learning. Degree programme descriptions were analysed and interviews were conducted with students and lecturers from the selected degrees, exploring their teaching and learning practices and experiences. Findings reveal predominantly country‐based differences in degree curriculum regarding students’ freedom to decide their learning path. Curricular flexibility and student input appear high in the English and Danish degrees and low in the Portuguese ones, despite attempts – so far little feasible in practice – to empower students to tailor learning to their interests. In drawing attention to the force of national pedagogic traditions in shaping curricula, the paper has implications for the degree comparability and student mobility advocated by recent European higher education reforms.
The Myth of the ‘Unfinished’ and the Film Das Dreimäderlhaus (1958)
Authors: Lindmayr-Brandl Andrea
Published: September 2016

Schubert’s ‘Unfinished’ Symphony has fascinated the musical world not only by its beauty but also through its rediscovery in the 1860s and the myths that have evolved around its composition. Firstly there is the rumour of a ‘hidden’ symphony—an accusation that goes back to Kreißle von Hellborn, who blamed the Hüttenbrenner brothers of holding back the most precious ‘perls’ of Schubert’s oeuvre. Secondly, there is a mystical relation to Beethoven which recurred in popular literature on Schubert, culminating in a scene of the film Das Dreimäderlhaus (1958) in which we see Schubert abandoning the composition of the symphony at the same time Beethoven was considered definitely to be deaf. Finally, the ‘Unfinished’ retains the nimbus of being a Sterbefragment—a work that was not finished because the composer died while working on it. Collectively, these myths form an important part of its reception history and contributed to its fame.
‘Die Wegweiser’—Signposts on an Accompanist’s Journey to Scholarship
Authors: Johnson Graham
Published: September 2016

This essay explores the relationship that has evolved across my career between musicology and the accompanist’s practice of performing and comprehending Schubert’s songs. It traces the path my own engagement with Schubert’s Lieder has taken, coordinated with the development of Schubert scholarship in this time, from the early impact of Eusebius Mandyczewski and later Otto Erich Deutsch, to the transformative work of Walter Dürr and the Neue Schubert-Ausgabe. I evaluate the ways in which Dürr’s work in particular has changed the way I approach Schubert’s music, pay tribute to the transformation of the Schubertian landscape that the Neue Schubert-Ausgabe has engineered, and offer reflections on the common causes that bind performers and Schubert scholars together.
“He knows the Koran by heart”
Authors: Einboden Jeffrey
Published: September 2016

The final chapter, reaching up to the Civil War and its immediate aftermath, focuses on Ralph Waldo Emerson, mapping the wide expanse between his public image and private practice. Emerson, a celebrated icon of American exceptionalism and philosopher of American Romanticism, is here revealed also as America’s most prolific translator of Islamic verse, rendering more than two thousand lines of Persian poetry through German sources. Scribbled through diaries, letters, even on the backs of envelopes, Emerson’s early appeal to the Qur’ān, and his later translations of Sufi poets—especially Muḥammad Shamsuddīn Ḥāfiẓ—are shown to have shaped Emerson’s own poetic identity, while also promoting his posthumous legacy.
Evolutionary conservation of Ebola virus proteins predicts important functions at residue level
Authors: Arslan Ahmed , van Noort Vera
Published: September 2016

Motivation

The recent outbreak of Ebola virus disease (EVD) resulted in a large number of human deaths. Due to this devastation, the Ebola virus has attracted renewed interest as model for virus evolution. Recent literature on Ebola virus (EBOV) has contributed substantially to our understanding of the underlying genetics and its scope with reference to the 2014 outbreak. But no study yet, has focused on the conservation patterns of EBOV proteins.

Results

We analyzed the evolution of functional regions of EBOV and highlight the function of conserved residues in protein activities. We apply an array of computational tools to dissect the functions of EBOV proteins in detail: (i) protein sequence conservation, (ii) protein–protein interactome analysis, (iii) structural modeling and (iv) kinase prediction. Our results suggest the presence of novel post-translational modifications in EBOV proteins and their role in the modulation of protein functions and protein interactions. Moreover, on the basis of the presence of ATM recognition motifs in all EBOV proteins we postulate a role of DNA damage response pathways and ATM kinase in EVD. The ATM kinase is put forward, for further evaluation, as novel potential therapeutic target.

Availability and Implementation

http://www.biw.kuleuven.be/CSB/EBOV-PTMs

Supplementary information

Supplementary data are available at Bioinformatics online.
3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 2: Surgical Management and Special Situations
Authors: Gionchetti Paolo , Dignass Axel , Danese Silvio , Magro Dias Fernando José , Rogler Gerhard , Lakatos Péter Laszlo , Adamina Michel , Ardizzone Sandro , Buskens Christianne J. , Sebastian Shaji , Laureti Silvio , Sampietro Gianluca M. , Vucelic Boris , van der Woude C. Janneke , Barreiro-de Acosta Manuel , Maaser Christian , Portela Francisco , Vavricka Stephan R. , Gomollón Fernando ,   on behalf of ECCO
Published: September 2016

This paper is the second in a series of two publications relating to the European Crohn’s and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn’s disease [CD] and concerns the surgical management of CD as well as special situations including management of perianal CD and extraintestinal manifestations. Diagnostic approaches and medical management of CD of this ECCO Consensus are covered in the first paper [Gomollon et al. JCC 2016].
No adverse effects detected for simultaneous whole-body exposure to multiple-frequency radiofrequency electromagnetic fields for rats in the intrauterine and pre- and post-weaning periods
Authors: Shirai Tomoyuki , Wang Jianqing , Kawabe Mayumi , Wake Kanako , Watanabe So-ichi , Takahashi Satoru , Fujiwara Osamu
Published: September 2016

In everyday life, people are exposed to radiofrequency (RF) electromagnetic fields (EMFs) with multiple frequencies. To evaluate the possible adverse effects of multifrequency RF EMFs, we performed an experiment in which pregnant rats and their delivered offspring were simultaneously exposed to eight different communication signal EMFs (two of 800 MHz band, two of 2 GHz band, one of 2.4 GHz band, two of 2.5 GHz band and one of 5.2 GHz band). Thirty six pregnant Sprague-Dawley (SD) 10-week-old rats were divided into three groups of 12 rats: one control (sham exposure) group and two experimental (low- and high-level RF EMF exposure) groups. The whole body of the mother rats was exposed to the RF EMFs for 20 h per day from Gestational Day 7 to weaning, and F1 offspring rats (46–48 F1 pups per group) were then exposed up to 6 weeks of age also for 20 h per day. The parameters evaluated included the growth, gestational condition and organ weights of the dams; the survival rates, development, growth, physical and functional development, memory function, and reproductive ability of the F1 offspring; and the embryotoxicity and teratogenicity in the F2 rats. No abnormal findings were observed in the dams or F1 offspring exposed to the RF EMFs or to the F2 offspring for any of the parameters evaluated. Thus, under the conditions of the present experiment, simultaneous whole-body exposure to eight different communication signal EMFs at frequencies between 800 MHz and 5.2 GHz did not show any adverse effects on pregnancy or on the development of rats.
On the surface physics affecting solar oscillation frequencies
Authors: Houdek G. , Trampedach R. , Aarslev M. J. , Christensen-Dalsgaard J.
Published: September 2016

Adiabatic oscillation frequencies of stellar models, computed with the standard mixing-length formulation for convection, increasingly deviate with radial order from observations in solar-like stars. Standard solar models overestimate adiabatic frequencies by as much as ∼ 20 μHz. In this Letter, we address the physical processes of turbulent convection that are predominantly responsible for the frequency differences between standard models and observations, also called ‘surface effects’. We compare measured solar frequencies from the Michelson Doppler Imager instrument on the SOlar and Heliospheric Observatory spacecraft with frequency calculations that include 3D hydrodynamical simulation results in the equilibrium model, non-adiabatic effects, and a consistent treatment of the turbulent pressure in both the equilibrium and stability computations. With the consistent inclusion of the above physics in our model computation, we are able to reproduce the observed solar frequencies to ≲3 μHz without the need of any additional ad hoc functional corrections.
Transvaginal Ultrasound Training for OBGYN Residents: Multi-site Randomized Controlled Trial of Educational DVD
Authors: High Brooke , McCurdy Rebekah , Brest Norman , Schnatz Peter , Baxter Jason , Jiang Xuezhi
Published: September 2016

BACKGROUND:

Despite ongoing advances in radiologic imaging, ultrasound remains the gold standard for most gynecologic diagnoses. Current practice in OB/GYN requires its frequent use and understanding, yet formal training is typically limited. In fact, while most residencies offer organized training in obstetric ultrasound, the education in gynecologic imaging is frequently inadequate, absent or not standardized. The American Institute of Ultrasound in Medicine developed a video called “Gynecology: Beginners Only” to improve resident knowledge and skills for transvaginal ultrasound. We introduced this DVD to residents with the goal of improving competency in gynecologic ultrasound.

METHODS:

Residents were recruited for a multi-site prospective study using the AIUM DVD, “Gynecology: Beginners Only.” All participants completed a pretest on gynecologic ultrasound images and principles. Subsequently, residents were randomly assigned to a viewing or control group. After watching the DVD, the viewers completed an identical posttest. Over a 6–10-month period, residents were encouraged to log ultrasounds on the ACGME case log system. All residents repeated the test at this time, and results were compared to prior results.

RESULTS:

Fifty-seven residents completed the training with a mean pretest score of 9.7 out of 15. The mean number of ultrasounds performed prior to the intervention was 31.5. The mean posttest score immediately after the intervention was improved at 11.2. However, this improvement did not persist as scores were not significantly improved several months later on a follow-up quiz for either the control or viewing groups. Hospital site, residency year, and experience did not appear to play a role in test scores.

DISCUSSION:

OB/GYN residents receive limited education in gynecologic ultrasound despite its frequent use. While residents would likely benefit from a structured curriculum, more research is needed to identify useful learning methods. Although the use of a DVD such as this is simple to implement and cost effective, it does not have a lasting impact on ultrasound knowledge. Exploration of different teaching modalities is necessary to create a more comprehensive training program and should likely include a hands-on component.
“Who Wants to Be an Ob/Gyne?” The Role of Blended Learning and Gaming for the Obstetrics and Gynecology Student: A Randomized Trial
Authors: Sampson Kimberley , Srinivasan Sunayana , Arynova Bakytbubu , Ahmed Seema
Published: September 2016

BACKGROUND:

We developed a PowerPoint game based on the TV game show, “Who wants to be a Millionaire.” Looking at gaming and blended learning to teach medical students high yield topics using Pearls of Exxcellence essential to practice obstetrics and gynecology.

METHODS:

A prospective study of 78 first and second year medical students. Cohort A: didactic style learning covering dermatological diseases. Cohort B: independent learning packet followed by team gaming activity “Who wants to an Ob/Gyne.” Assessment: Pre and post-course knowledge and Likert scale surveys. Long term retention: repeat testing at 6 months interval.

RESULTS:

Both groups showed significant improvement in learning (P<.001) on pre- and posttest comparison. Blended learning achieved greater pretest to post-test improvement of high statistical significance (P<.001) compared to didactic learning alone. Students in the group randomized to game format rated it higher in create team comradery and overall enjoyment than students participating in the lecture method (P<.001). In addition, students in the blended learning group responded positively that the format had stimulated their interest, and kept them engaged in class content (P<.001). Six months retest the intervention group had greater retention in clinical knowledge scores (1.2±2.6 versus 3.5±1.8; P=.02).

DISCUSSION:

Blended learning incorporating gaming is an effective and acceptable pedagogical alternative to didactic lectures. Showing both an immediate and 6-month retention benefit.
Delivering Bad News in Obstetrics and Gynecology Residency: A Pilot Curriculum to Address Identified Training Gaps
Authors: Murphy Jessica , Jeronis Stacey , Kean Kristin , Rose Marisa
Published: September 2016

BACKGROUND:

A recent literature review identified no publications on resident training in diagnosing and counseling patients on fetal demise. A previous needs assessment identified resident training gaps in the following areas: 1) communication skills in delivering bad news, 2) bereavement support and 3) counseling and consenting for the postmortem evaluation of the stillborn.

METHODS:

A 3-pronged curriculum, created and implemented to address the identified needs, included: directed readings, didactic lectures, and standardized patient simulation. Residents were surveyed pre and post-intervention to assess impact of the curriculum. Results were compared using McNemar's Test.

RESULTS:

Fourteen of 21 residents completed the curriculum. Resident self-assessed confidence significantly increased in: initiating proper workup after stillbirth (85.7% post versus 50% pre-intervention, P=.025), addressing patient anxiety and grief (100% post versus 71.43% pre, P=.045), and consenting for autopsy (100% post versus 50% pre, P=.008). The curriculum successfully addressed the gaps in training identified in grief management and autopsy counseling. A post-intervention objective measure demonstrated significant improvement in resident knowledge.

DISCUSSION:

This novel curriculum significantly improved residents' confidence and competence in diagnosing and counseling a fetal demise. Our department has integrated this successful training program into the residents' formal curriculum. We are sharing it as a model with neighboring institutions to further evaluate and expand this project.
Do Faculty and Residents Agree on Obstetrics and Gynecology Surgical Training Needs?
Authors: Braun Kelli , Swift Steven , Stepleman Lara
Published: September 2016

BACKGROUND:

Surgical education is an essential, complex, component of residency training. Resident and faculty needs are important in guiding the educational agenda; studies demonstrate that these groups do not always agree on needs.

METHODS:

A 50-item needs assessment tool was administered during scheduled meetings at our single academic center to capture resident and faculty perceptions of the adequacy of our program's surgical training; all items were ranked on a 5-point agreement scale. Content domains included feedback, surgical preparation, intra-operative performance, simulation, and the Ob-Gyn Milestones procedures (we assessed satisfaction with training and the perceived helpfulness of simulation to improve performance of those procedures).

RESULTS:

Twelve surgical faculty (80%) and 13 residents (87%) completed the needs assessment; t tests compared resident/faculty group differences. Both groups agreed on the adequacy of surgical content domains, however, faculty consistently self-reported delivering feedback at a significantly higher level than residents' perceived receiving it (P<.05). Both groups were least satisfied with training in cystotomy repair, breech vaginal delivery, and 3rd/4th-degree laceration repair. Both rated simulation in breech vaginal delivery and vaginal hysterectomy as most useful for improving performance. For all procedures, faculty consistently rated at significantly higher levels, simulation's usefulness to improve procedure performance.

DISCUSSION:

Although residents and faculty agree on areas needing most improvement, differences exist in perception of feedback and usefulness of simulation to improve performance.
Does an Intensive and Multimodal Intern Boot-Camp Prepare Incoming Residents for Level 1 Milestones?
Authors: Tschirhart Monica , DeSilva Nirupama
Published: September 2016

BACKGROUND:

Residents coming from different medical schools often have variations in their knowledge and skill sets. This has led to frustration and confusion amongst the not only the new residents, but also the upper-level residents and the faculty. Furthermore, many residents entered PGY1 achieving few level 1 Milestones.

METHODS:

We prepared an intensive curriculum focusing on achievement of level 1 Milestones during orientation for PGY1 residents that consisted of lectures, simulations, and e-modules. The residents' readiness was assessed before and after orientation using the PrepforRes: The APGO Preparation for Residency Knowledge Assessment Tool. The residents also took a post-orientation survey to assess their satisfaction with the curriculum. They will retake the survey in December and June to assess longer term satisfaction with the curriculum.

RESULTS:

Average PGY1 score prior to orientation was 60 with a standard deviation of 8.4. No incoming resident passed the exam. After the “boot-camp” average score was 82 with a standard deviation of 1.8 and every resident passed the exam. Overall there was a 37% increase in scores. Survey results indicated that the residents were satisfied with the curriculum. They all reported that they felt an increased connection as a class and indicated a desire to continue group study activities.

DISCUSSION:

A more robust orientation curriculum provided a substantial increase in resident readiness as measured by the PrepforRes test. Additionally the residents were satisfied with the curriculum and feel that it was helpful before starting residency. We will resurvey these residents at 6 months and 1 year to determine any additions or adjustments to the program. A side benefit seen was that the standard deviation decreased significantly from the pretest to the posttest. This may serve to place all the PGY1 residents on a more even footing when interacting with both other residents and faculty.
How Does the First Clerkship Affect Medical Students' Views of the Relationship Between Physicians and Nurses?
Authors: Morgan Helen , Skinner Bethany , Bailey Joanne , Hammoud Maya
Published: September 2016

BACKGROUND:

Preparing future physicians to work collaboratively with nurses is a must for today's educators. Effective physician-nurse collaboration improves patient care and health outcomes. Medical students' views of the physician-nurse relationship and how these views may evolve during their clerkships have not been well examined.

METHODS:

Medical students on their first clinical clerkship completed the Jefferson Survey of Attitudes Towards Physician-Nurse Collaboration on the first and last day of their 6-week obstetrics and gynecology clerkship. This 20-question instrument addresses areas of responsibility and collaboration between physicians and nurses and has construct validity and reliability. All questions used a 4-point Likert scale (1=strongly disagree, 4=strongly agree). Pre- and post-clerkship scores were compared using paired t tests.

RESULTS:

Twenty-five students completed the pre- and post-surveys with a 100% response rate. Students overall had positive views of the physician-nurse relationship. At the completion of the clerkship, medical students felt more strongly that “during their education; medical and nursing students should be involved in teamwork in order to understand their respective roles” (pre: 3.82, post: 3.95, P=.042), and that “there are many overlapping areas of responsibility between physicians and nurses” (pre: 3.26, post: 3.57, P=.008).

DISCUSSION:

Our work reveals promising data that medical students begin their clinical clerkships with positive views of the physician-nurse relationship. Furthermore after the completion of their first clerkship, the students had significantly higher views of the importance of collaboration and shared responsibility.
Impact of Incivility and Self-Compassion on Burnout in Healthcare Workers
Authors: Stewart Tamika , Hadaya Ola , Jaber Sara , Sangha Roopina , Jesse Michelle , Richardson David
Published: September 2016

BACKGROUND:

There is a large body of literature discussing CS, BO and STS in physicians, residents, medical students and nurses. Mid-level providers (MLPs) have not previously been assessed. Incivility has correlated to burnout in other professions, but not been assessed in a healthcare environment. Other constructs of psychological flexibility have rarely been evaluated.

METHODS:

A survey was sent to 501 MLPs. One hundred fifty-five completed the survey. The survey included: demographics, the Professional Quality of Life Scale, the Self Compassion Scale (SCS), the Perceived Stress Scale, the Satisfaction with Life Scale, the Interpersonal Reactivity Index, the Resilience Scale, the Workplace Incivility Scale, and the Health Provider Shame Scale.

RESULTS:

Approximately 38% of respondents fulfilled criteria for BO and 20% reported a high degree of incivility in the workplace. Residents and staff physicians were identified most often as the culprits. Significant predictors of BO included: SCS (β=−0.203, P=.04), incivility (β=0.233, P=.003), and perceived stress score (β=0.159, P=.001).

DISCUSSION:

Perceived incivility in the workplace can significantly impact BO, STS, and a decrease in CS in health care workers. The lack self-compassion increases individual's risk for BO. Programs to decrease burnout must look at not only how we relate to others, but how we relate to ourselves.
Implementation of a Maternal Health Curriculum and Distance-Learning Program in South Sudan
Authors: Espinoza Cholene , Achiek Mayen , Clunes Mark , Kokar Chatchai , Silverstein Zach , Wong Melissa
Published: September 2016

BACKGROUND:

Every woman in South Sudan has a 1 in 7 chance of dying in childbirth. There are no post-graduate training programs in Obstetrics and Gynecology, so that MBBS-qualified doctors remain especially underprepared in maternal and neonatal care. Due to concerns for political instability and safety, a distance learning module was needed.

METHODS:

We first identified topics most pertinent to undergraduate MBBS education in maternal health. We next developed a delivery system for the content as well as obtained funding. We sought resources for the content of the didactics themselves and a method to ensure effective interactive learning.

RESULTS:

From our university's core lectures, we identified critical topics pertinent to maternal care in South Sudan. We secured funding through a nonprofit organization to obtain 84 digital tablets. Eighty-one pre-recorded lectures were loaded onto the devices, which were then distributed to the MBBS students. Two hours daily of small group discussion by our university's facilitator accompanied the lectures. Written tests (n=187) following the intervention showed substantial knowledge acquisition (mean score=63%; SD±12.8%). Debriefing sessions revealed unanimously positive responses to the intervention, particularly to the group discussions.

DISCUSSION:

The use of pre-recorded lectures on tablets and facilitated discussion resulted in successful implementation of a distance-learning program for maternal health in an underserved country. Future research will assess the sustainability and effectiveness of this intervention.
Perceived Stress on Labor and Delivery (L&D) During OB/GYN Clerkship From Students, Residents, and Faculty's Perspectives
Authors: Chen Xiaodong , Johnson Natasha
Published: September 2016

BACKGROUND:

Appropriate stress levels can stimulate medical trainees to think and react quickly. However, little is known about the effects of stress on medical students' learning on L&D which is characterized by a complex, dynamic and unpredictable teamwork environment. Likewise the specific factors contributing to students' stress on L&D have not been reported.

METHODS:

Individual interviews were conducted with 3 consecutive cohorts of students at the end of their OB/GYN clerkships and a group of OB/GYN residents and faculty through convenience sampling in 2015. Participants were asked to identify the most stressful clinical setting during the clerkship and factors contributing to the stress in this environment. Thematic analysis and manual coding were applied to code and synthesize the data to identify the perceived stressful factors among students, residents, and faculty.

RESULTS:

L&D was the most stressful learning environment during the OB/GYN clerkship as reported by 14/19 students (73.7%). A total of 11 stressful factors from 4 categories were identified: 2 (terminology, interacting with residents) classified as Interpersonal Communication; 4 (pace, logistics, intrinsic sensitive nature of L&D, non-routine schedule) considered as Context; 3 (crisis, emergency, patient refusal of student involvement) fell into Clinical Scenario; 2 (student role and assignment, the amount of new knowledge and skills required) identified as Learning Tasks. Most residents and faculty (75%) reported that factors from Context would contribute to students' stress on L&D, and all students (100%) agreed. The majority of residents and faculty believed factors from Learning Tasks were stressful for students; but only 26.3% of students shared the same perception.

DISCUSSION:

Context factors contributing to stress were perceived by students, residents and faculty alike as contributing to stress and considered non-controllable, whereas OB/GYN residents and faculty differed in the perception of the effects of Learning Tasks on stress from students' perception. Clerkship programs are encouraged to integrate preparation of Context into curriculum through educational interventions to optimize students' stress level without increasing residents' and faculty's teaching pressure.
Resident Education Using a Novel, Low-Cost Postpartum Hemorrhage Simulator With Quantifiable Blood Loss
Authors: Porter Blake , Levy Deborah , Mundy David , Babbar Shilpa , Williams Karen , Maulik Dev
Published: September 2016

BACKGROUND:

Postpartum hemorrhage is a common and potentially life threatening obstetrical emergency that has shown to be amenable to simulation.

METHODS:

Fourth year OB/GYN residents participated in a standardized simulation scenario of management of a PPH, prior to and after an educational intervention. The scenario used a novel simulator that quantifies blood loss and was built from low-cost, readily available materials. Residents then underwent an educational debriefing including instruction on PPH management and quantified feedback from their performance during the pretest simulation. Two months later, residents underwent posttesting using a similar PPH simulation. Statistical analysis used paired t test with P-value of less than .05 considered significant.

RESULTS:

Seven residents completed the pilot study. After the educational debriefing, residents performed corrective interventions earlier in the hemorrhage scenario. The primary outcome, total blood loss at the time of decision to perform exploratory laparotomy, significantly decreased 23% from 2,271 mL on pretest as compared to 1,743 mL on posttest simulation (P=.03). The residents' ability to accurately estimate blood loss improved, however this trend did not reach statistical significance (P=.15).

DISCUSSION:

Simulation training using this novel, low-cost PPH simulator allows for blood loss at the time of interventions to be accurately recorded and used in educational debriefings. Debriefing using management guidelines and quantified information on resident performance improved resident performance on follow up testing at 2 months.
Retention of Laparoscopic and Robotic Skills 12 Weeks After Simulation Training
Authors: Orlando Megan , Thomaier Lauren , Abernethy Melinda , Chen Chi Chiung Grace
Published: September 2016

BACKGROUND:

Although minimally invasive simulation modeling provides a supplement for traditional surgical training, there is less objective data on longer-term skills retention.

METHODS:

We present the second stage of a randomized single-blinded controlled trial in which 40 simulation-naive medical students were randomly assigned to practice pegboard transfer tasks on either laparoscopic (N=20, Fundamentals of Laparoscopic Surgery, VT Medical Inc., Waltham, MA) or robotic (N=20, dV-Trainer, Mimic, Seattle, WA) platforms. In the first stage, two expert surgeons evaluated participants on both tasks immediately after training using previously validated global rating scales of laparoscopic operative performance. In the second stage, participants were evaluated on both tasks 12 weeks after training.

RESULTS:

Of the 40 participants who participated in the initial training phase, 23 (11 laparoscopic and 12 robotic) underwent repeat evaluation. Twelve weeks after training, there were no significant differences between groups in objective measures or global rating scale composite scores for the laparoscopic task. However, the robotic practice group demonstrated significantly higher global rating scale composite scores on the robotic simulation task (11.8 versus 9.4, P=.04). Robotic training was associated with improved economy of motion (P=.017) and fewer ring drops (P=.018) on the robotic platform.

DISCUSSION:

Robotic skills acquired through simulation appear to be easier to maintain than laparoscopic skills gained via simulation.
Description and Evaluation of Peer Review of Teaching in an Integrated Medical School Curriculum
Authors: Strafford Katherine , Tartaglia Kimberly , Mahan John , Nagel Rollin , Verbeck Nicole , Davis John
Published: September 2016

Local Mentor: John Davis, MD

APGO Advisor: Nancy Hueppchen, MD, MSc

PURPOSE:

(Hypothesis) Using a group of Expert Educators, reliable peer review of clinical didactics can be provided to medical school faculty in an integrated curriculum.

BACKGROUND:

Recognition of effective teaching and faculty development to promote excellence in teaching should be curricular goals. Peer review can be a challenging component of teaching evaluation to institute. We sought to evaluate the consistency of reviewers in a newly implemented peer review program.

METHODS:

In an observational study of teaching in integrated clerkships, faculty leading didactic sessions were peer-reviewed by select faculty, “Expert Educators” (EEs). EEs reviewed sessions across all disciplines in the 3rd year clinical curriculum. EEs underwent faculty development training in peer observation and the giving of feedback, and used standard twelve item forms created using resources from the Stanford Faculty Development Program. Where possible, EEs were paired to provide a review on the same didactic session. We compared paired reviews using percent agreement as a means of assessing the consistency of feedback generated.

RESULTS:

Twenty paired and 44 individual peer reviews were completed by EEs. Analysis of the paired reviews showed average agreement by case was 52% but rose to 87% when data were grouped by acceptable/not acceptable scores.

DISCUSSION:

EEs have moderate agreement when reviewing the same didactic session and high agreement when elements were analyzed as acceptable/not acceptable. We plan to use taped lecture review by 3–4 EEs to continue assessment of rater reliability. Additional future directions include comparisons of peer reviews with reviews from curriculum leaders, students and faculty self-reflections.
Determining the Minimum Number of Ultrasound Simulations to Establish Competency
Authors: Shanks Anthony , Durst Jennifer , Temming Lorene , Colvin Ryan
Published: September 2016

Local Mentor: Eric Strand, MD

APGO Advisor: Nancy Hueppchen, MD, MSc

PURPOSE:

To determine the number of simulations that are required to provide the novice learner with comparable ultrasound skills to a PGY1 Intern.

BACKGROUND:

There is renewed emphasis on training medical students prior to the start of residency. The VIMEDIX OB simulator offers the ability to simulate ultrasound images although the ideal integration into training is unknown.

METHODS:

Prospective cohort study of OB/GYN residents (n=33) and medical students entering OB/GYN residency (n=12). IRB approval was obtained prior to the start of the study. Each resident took a timed test on US image fetal biometry acquisition (head circumference, abdominal circumference and femur length). Accuracy and mean times (seconds) were established for PGY1, PGY2, PGY3 and PGY4 years. Medical students comprised the intervention cohort. The students performed timed growth scans after completing 1, 5, 10 and 15 simulations. Accuracy was then compared to PGY1, PGY2, PGY3 and PGY4 years.

RESULTS:

Thirty-three residents completed the study. Resident accuracy in obtaining satisfactory images for growth US decreased with advancing PGY year from 85.7% as a PGY 1 to 50% as a PGY4. Ten medical students completed all simulations for analysis. Accuracy was 41.7% after one simulation and 90.9% after 5.

DISCUSSION:

The use of an ultrasound simulator demonstrated that novice learners had to perform 5 simulations to demonstrate comparable growth scan accuracy to a PGY 1. Ultrasound accuracy decreased with advancing year in residency suggesting that skills should be maintained during training.
Does Team-Based Learning Improve In-Training Exam Scores Among Obstetrics and Gynecology Residents?
Authors: Melendez Elizabeth
Published: September 2016

Local Mentor: Sam Cullison, MD

APGO Advisor: John L. Dalrymple, MD

PURPOSE:

To determine if the incorporation of team-based learning into an OBGYN residency affects performance on in-training examinations.

BACKGROUND:

Residents at our institution spend more time on general obstetrics and gynecology (OBGYN). However, their scores on in-training examinations in these subject areas are lower than in the subspecialties. To improve knowledge in general OBGYN as measured by performance on the examination, team-based learning (TBL) was introduced.

METHODS:

Since July 2014, teams complete assignments prior to TBL sessions on general OBGYN topics. At the start of each session, residents take a readiness assessment test prior to applying knowledge through clinical scenarios. As these scenarios are discussed, test questions are reviewed for correct answers. OBGYN subject area scores from the in-training examination taken in January 2014 were compared to scores in 2015. Pre- and post-examination surveys were taken to assess attitudes toward TBL and perceived examination preparedness.

RESULTS:

Twelve residents participated in TBL sessions (3/year × 4). Total scores for all PGY levels improved after TBL was introduced, with the greatest improvement noted from PGY1 to PGY2 (57.3, SD 3.2 versus 62.7, SD 3.1). Scores from 3 years prior showed similar improvements. Among OBGYN subject areas, scores were higher in gynecology for all 4 PGY levels after TBL was introduced. More residents felt TBL better prepared them for the examination when surveyed before the examination compared to after (11 versus 8 residents).

DISCUSSION:

A TBL curriculum improved resident knowledge as measured on the in-service examination in gynecology, making TBL a useful tool in the armamentarium of resident educators.
How Does OBGYN Resident Training at Restrictive Faith-based Institutions Impact Subsequent Provision of Reproductive Healthcare for Women? A Qualitative Analysis
Authors: Guiahi Maryam , Hoover Jennifer , Swartz Maryke , Teal Stephanie
Published: September 2016

Local Mentor: Stephanie Teal, MD, MPH

ASL Advisor: Nancy Hueppchen, MD, MSc

PURPOSE:

To understand how institutional restrictions at faith-based hospitals impact OBGYN trainees who subsequently provide care for women at secular institutions.

BACKGROUND:

OBGYN residency prepares trainees to become experts in women's healthcare. Trainees at faith-based hospitals may not receive adequate training in family planning services.

METHODS:

We set out to conduct semi-structured individual interviews with recent graduates from 10 faith-based hospitals who are generalists at secular institutions. Participants were queried about their experiences, perceived deficiencies, and current provision of family planning services. Three researchers independently coded transcripts using grounded theory; overarching themes and discrepancies were subsequently resolved.

RESULTS:

15/31 graduates from 7 hospitals participated; we reached thematic saturation after analysis of these interviews. None of the participants cited a preference to match at their program based on restrictive family planning policies. All participants reported reproductive healthcare training deficiencies that were partially attenuated by didactic educational activities, variations in on-site restrictions, and off-site training. Participants expressed frustration about inadequate on-site training in postpartum tubal ligations; upon graduation they either avoided provision or required mentorship from partners to achieve competency. A few participants who sought off-site training now provide outpatient D&Cs and/or inpatient D&Es. All participants proposed that faith-based programs improve family planning training by providing routine, opt-out opportunities.

DISCUSSION:

OB-GYNs trained at faith-based institutions feel that religion-based policies negatively impact training experiences and the range of health services they subsequently can provide. Forming collaborations with off-site facilities, particularly for tubal ligation and outpatient uterine evacuation procedures, may improve the reproductive care these physicians provide to women.
Let's Talk About Sex History: Impact of a Communication Curriculum on Medical Student Performance and Perceived Competency
Authors: Stockdale Colleen K. , Rosenbaum Marcy , Kippes John , Elson Marygrace
Published: September 2016

Local Mentor: Marygrace Elson, MD, MME

APGO Advisor: Nancy Hueppchen, MD, MSc

PURPOSE:

Determine whether medical students (MS) who completed a sexual history communication curriculum performed better during a formal standardized patient based assessment (PBA) at the conclusion of the OB/GYN Clerkship than historical control MS, and assess MS perceptions about taking a sexual history.

BACKGROUND:

Communication is inadequately addressed in undergraduate medical education. Students often feel they are poorly trained in this area due to a lack of opportunities to practice taking sexual histories. Thus, a communication curriculum was implemented to address this gap, including formal small group practice sessions on taking a sexual history during the OB/GYN Clerkship.

METHODS:

Retrospective study comparing 3 specific PBA standardized patient rating questions and 5 questions regarding MS feedback. All (n=66) MS between January and June 2011 were queried at the conclusion of their OB/GYN Clerkship before implementation of the sexual history curriculum in July 2011 with responses compared to all subsequent (n=421) MS through June 2014. Cochran-Mantel-Haenszel was used to compare scores by Clerkship year and block with P<.05 significant.

RESULTS:

There was no change in MS PBA performance or MS perception regarding ability to take a sexual history immediately following implementation of the sexual history communication curriculum. However, in response to “what other instruction or experiences could the clerkship provide to help you gain competency…” the theme was more practical experience.

DISCUSSION:

Learners require different formats to promote and enhance learning, which may not have been measured with the outcomes chosen for this study.