bluuebunny/crossref_metadata_2025 huggingface dataset:
Earlier nesting by generalist predatory bird is associated with human responses to climate change
Authors: Smith Shawn H. , Steenhof Karen , McClure Christopher J.W. , Heath Julie A.
Published: November 2016

Warming temperatures cause temporal changes in growing seasons and prey abundance that drive earlier breeding by birds, especially dietary specialists within homogeneous habitat. Less is known about how generalists respond to climate‐associated shifts in growing seasons or prey phenology, which may occur at different rates across land cover types.

We studied whether breeding phenology of a generalist predator, the American kestrel (Falco sparverius), was associated with shifts in growing seasons and, presumably, prey abundance, in a mosaic of non‐irrigated shrub/grasslands and irrigated crops/pastures. We examined the relationship between remotely‐sensed normalized difference vegetation index (NDVI) and abundance of small mammals that, with insects, constitute approximately 93% of kestrel diet biomass. We used NDVI to estimate the start of the growing season (SoGS) in irrigated and non‐irrigated lands from 1992 to 2015 and tested whether either estimate of annual SoGS predicted the timing of kestrel nesting. Finally, we examined relationships among irrigated SoGS, weather and crop planting.

NDVI was a useful proxy for kestrel prey because it predicted small mammal abundance and past studies showed that NDVI predicts insect abundance. NDVI‐estimated SoGS advanced significantly in irrigated lands (β = −1·09 ± 0·30 SE) but not in non‐irrigated lands (β = −0·57 ± 0·53). Average date of kestrel nesting advanced 15 days in the past 24 years and was positively associated with the SoGS in irrigated lands, but not the SoGS in non‐irrigated lands. Advanced SoGS in irrigated lands was related to earlier planting of crops after relatively warm winters, which were more common in recent years.

Despite different patterns of SoGS change between land cover types, kestrel nesting phenology shifted with earlier prey availability in irrigated lands. Kestrels may preferentially track prey in irrigated lands over non‐irrigated lands because of higher quality prey on irrigated lands, or earlier prey abundance may release former constraints on other selective pressures to breed early, such as seasonal declines in fecundity or competition for high‐quality mates.

This is one of the first examples of an association between human adaptation to climate change and shifts in breeding phenology of wildlife.
Words and Paradigms: Peter H. Matthews and the Development of Morphological Theory
Authors: Anderson Stephen R.
Published: November 2016

A comprehensive review of linguistic accounts of the structure of words and their relation to one another would of course have to begin long ago, with the work of grammarians in the classical Sanskrit, Greek, Latin, Arabic and other traditions. As a starting point for an understanding of the views on morphology held by linguists today, though, it seems reasonable to focus on the development of this field over the course of the twentieth century, and especially during the last half of that century, a period in which the work of Peter Matthews played a particularly important role.
The Value of Outsourcing Selected Cases in a Medical Examiner Population: A 10‐Year Experience
Authors: McCleskey Brandi C. , Reilly Stephanie D. , Atherton Dan
Published: November 2016

Due to increasing caseloads and inadequate staffing, the burden on Coroner/Medical Examiner Offices to comply with recommended autopsy limits for forensic pathologists (FPs) has been difficult. Since 2006, pathologists at the University of Alabama at Birmingham have performed select autopsies for the Alabama Department of Forensic Sciences. Each case was reviewed by a state FP and scene investigator to determine appropriateness for referral. All referred cases received full postmortem examination including microscopic examination and collection of toxicological samples, and toxicology was ordered by the referring FP as appropriate. The final cause and manner of death were determined by the referring state FP after review of all findings. A majority of the 421 cases were ruled accidental deaths (233), most due to drug toxicity. Of the 178 natural deaths, 118 were attributed to cardiovascular disease. Outsourcing select forensic cases can be educational and an effective tool to manage workflow without compromising quality.
The Visual Journey of Manon Lescaut: Emblematic Tendencies and Artistic Innovation
Authors: Ionescu Christina
Published: November 2016

The visual corpus of Manon Lescaut is a rich and complex ensemble. In this article I discuss five prevalent and distinct tendencies in the illustration of Prévost's novel, looking at iconographic series that are highly original and/or particularly intriguing in the interpretation they propose of this canonical text. I have chosen examples from five time periods (the Directory, the Romantic era, the Belle Epoque, the inter‐war years and the 1950s) and two geographic regions (France and America). I focus on book illustration as a receptacle for artistic creativity, a site for the reception of the text and a locus for strategic marketing.
Picturing Les Liaisons Dangereuses: Eighteenth‐Century Illustrations of Laclos's Novel
Authors: Seth Catriona
Published: November 2016

Laclos never commissioned illustrations for Les Liaisons dangereuses (1782). Nevertheless, a set of prints destined to be framed and four series of illustrations to accompany editions of the book came out during his lifetime. The artists – not all of whom can be identified – vary in the choice of scenes they represent. There are also two allegorical frontispieces which show that the text can be interpreted as a tragic moral tale. The engravings range from the libertine to the demure, from crudely sketched small plates to exquisitely delineated large prints. They offer precious insights into the contemporary reception of the novel.
Older patients' consultations in an apprenticeship model‐based general practice training program: A cross‐sectional study
Authors: Bonney Andrew , Morgan Simon , Tapley Amanda , Henderson Kim , Holliday Elizabeth , Davey Andrew , van Driel Mieke , Spike Neil , Regan Cathy , Ball Jean , Magin Parker
Published: November 2016

Objective

To investigate older patients' encounters with general practice registrars (GPRs) to inform training and clinical practice.

Methods

Cross‐sectional analysis of data from GPR consultations across five regional training providers in Australia. Data were analysed using simple and multiple logistic regression models.

Results

Our analysis included details of 118 831 consultations, 20 555 (17.6%, 95% CI 17.4–17.8) with patients aged ≥65 years. Older patient encounters had an increased likelihood of including chronic disease (OR 1.77, 95% CI 1.70, 1.86) and more problems (OR 1.24, 95% CI 1.20, 1.27). However, in‐consultation information or advice was less likely to be sought (OR 0.92, 95% CI 0.88, 0.97), and consultations were briefer (OR 0.99, 95% CI 0.99, 1.00).

Conclusion

Our results suggest relatively limited GPR exposure to older patients coupled with less complex consultations than expected. Solutions will need to be carefully constructed not only to increase caseloads, but also to address training and supervision concerns.
Field‐testing the new anaphylaxis' classification for the WHO International Classification of Diseases‐11 revision
Authors: Tanno L. K. , Molinari N. , Bruel S. , Bourrain J.‐L. , Calderon M. A. , Aubas P. , Demoly P. ,   the Joint Allergy Academies
Published: November 2016

Background

To consolidate the new classification model addressed to the allergic and hypersensitivity conditions according to the International Classification of Diseases (ICD)‐11 revision timeline, we here propose real‐life application of quality assurance methodology to evaluate sensitivity and accuracy of the ‘Anaphylaxis’ subsection.

Methods

We applied field‐testing methodology by analysing all the consecutive inpatients’ files documented as allergies from the University Hospital of Montpellier electronic database for the period of 1 year. The files clinically validated as being anaphylaxis were manually blind‐coded under ICD‐10 and current ICD‐11 beta draft. The correspondence of coding and the impressions regarding sensibility were evaluated.

Results

From all 2318 files related to allergic or hypersensitivity conditions, 673 had some of the anaphylaxis ICD‐10 codes; 309 files (46%) from 209 patients had anaphylaxis and allergic or hypersensitivity comorbidities description. The correspondence between the two coders was perfect for 162 codes from all 309 entities (52.4%) (Cohen‐kappa value 0.63) with the ICD‐10 and for 221 codes (71.5%) (Cohen‐kappa value 0.77) with the ICD‐11. There was a high agreement regarding sensibility of the ICD‐11 usability (Cohen‐kappa value 0.75).

Conclusion

We here propose the first attempt of real‐life application to validate the new ICD‐11 ‘Anaphylaxis’ subsection. Clearer was the improvement in accuracy reaching 71.5% of agreement when ICD‐11 was used. By allowing all the relevant diagnostic terms for anaphylaxis to be included into the ICD‐11 framework, WHO has recognized their importance not only to clinicians but also to epidemiologists, statisticians, healthcare planners and other stakeholders.
A Comparison of Two Surgical Techniques for the Second Stage of Brachiobasilic Arteriovenous Fistula Creation
Authors: Mauro Raffaella , Pini Rodolfo , Bianchini Massoni Claudio , Donati Gabriele , Faggioli Gianluca , Gargiulo Mauro , Freyrie Antonio , La Manna Gaetano , Stella Andrea
Published: November 2016

Two‐stage transposed brachiobasilic arteriovenous fistula is a common procedure after brachiobasilic fistula (BBF) creation. Different techniques can be used for basilic vein transposition but few comparative literature reports are available. The aim of our study was to compare two different techniques for basilic vein transposition. The first maintains the BBF anastomosis and the basilic vein is placed in a subcutaneous pocket (BBAVF). The second transects the basilic vein at the BBF anastomosis and tunnels it superficially, with a new BBF in the brachial artery (BBAVFTn). From 2009 to 2014, all patients who underwent basilic vein superficialization were treated by one of the two techniques, recorded in a dedicated database and retrospectively reviewed. The surgeon chose the technique on the basis of personal preference. The two techniques were compared in terms of perioperative complications, length of hospital stay, time of cannulation, ease of cannulation, and long‐term patency. Eighty patients were included in the study: 40 (50%) BBAVF and 40 (50%) BBAVFTn. Length of hospital stay was similar in the two groups (median [interquartile range–IQR] 3(2) [BBAVF] vs. 2(1) [BBAVFTn], P = 0.52, respectively). BBAVFTn was associated with a lower hematoma incidence (1/40 [2.5%] vs. 15/40 [37.5%], P = 0.01), shorter first cannulation time (median IQR: 11(10) vs. 23(8) days, P = 0.01) and easier cannulation compared with BBAVF (32/40 [80%] vs. 15/40 [37.5%], P < 0.001). Median (IQR) follow‐up was 16(7) months. No statistical differences in terms of primary and assisted primary patency were found in BBAVFTn vs. BBAVF (at 24 months 91(5) vs. 71(7), P = 0.21 and 93(6) vs. 78(8), P = 0.33, respectively). Patients who underwent BBAVFTn surgery showed fewer surgical complications, better dialytic performance, and easier cannulation compared with those submitted to BBAVF.
Evaluation of a foster parent intervention for foster children with externalizing problem behaviour
Authors: Van Holen Frank , Vanschoonlandt Femke , Vanderfaeillie Johan
Published: November 2016

Background

The aim of this Flemish study (Dutch speaking part of Belgium) is to evaluate the efficacy of an intervention based on the social learning theory for foster parents who take care of a foster child (ages 3–12) with externalizing problem behaviour (a borderline or clinical score on the externalizing broad‐band or on one of the externalizing problems scales of the Child Behaviour Checklist), with respect to breakdown, foster children's externalizing problems and foster mothers' parenting stress.

Methods

A randomized controlled trial was used to compare, at baseline, post‐intervention and three‐month follow‐up, an intervention group (n = 30) with a treatment as usual control group (n = 33) consisting of foster parents of new placements recruited via a routine screening or on‐going placements signed up by their foster care worker. The intervention consists of 10 home sessions.

Results

The intervention had significant small short‐term en large long‐term effects on externalizing problems and medium short‐term and long‐term effects on parenting stress. No significant effects were found on the breakdown rate.

Conclusions

Giving the evidence for its effects on foster children's externalizing and foster mothers' parenting stress, implementation of this foster parent intervention might increase the effectiveness of foster care.
Simulation‐Based Optimization of Capacitated Assembly Systems under Beta‐Service Level Constraints
Authors: Woerner Stefan , Laumanns Marco , Wagner Stephan M.
Published: November 2016

We study a class of capacitated assembly systems operated by base‐stock policies and address the problem of finding base‐stock levels that minimize holding costs under beta‐service level (fill rate) constraints over an infinite horizon. To solve this nonconvex constrained optimization problem, we develop a new simulation‐based optimization approach using the constrained level method (CLM) and infinitesimal perturbation analysis. The key idea of the algorithm is a novel family of convex approximations of the beta‐service level, which is iteratively refined during the course of the algorithm. The algorithm can easily handle integrality requirements for the base‐stock levels by combining the CLM with a cutting plane approach without significantly increasing the solution time on typical instances. We apply our approach to a comprehensive multi‐echelon assembly benchmark system from the literature and study the algorithm's behavior for different target service levels, capacity configurations, and simulation horizons. A comparison with a state‐of‐the‐art interior point algorithm shows that for realistic capacity constraints, our algorithm is on average 8%–20% better. Compared with the guaranteed service model, our approach reduces costs by 10%–15% while keeping the same service level.
Blindness to background: an inbuilt bias for visual objects
Authors: O'Hanlon Catherine G. , Read Jenny C.A.
Published: November 2016

Sixty‐eight 2‐ to 12‐year‐olds and 30 adults were shown colorful displays on a touchscreen monitor and trained to point to the location of a named color. Participants located targets near‐perfectly when presented with four abutting colored patches. When presented with three colored patches on a colored background, toddlers failed to locate targets in the background. Eye tracking demonstrated that the effect was partially mediated by a tendency not to fixate the background. However, the effect was abolished when the targets were named as nouns, whilst the change to nouns had little impact on eye movement patterns. Our results imply a powerful, inbuilt tendency to attend to objects, which may slow the development of color concepts and acquisition of color words. A video abstract of this article can be viewed at: https://youtu.be/TKO1BPeAiOI. [Correction added on 27 January 2017, after first online publication: The video abstract link was added.]
miR‐219 attenuates demyelination in cuprizone‐induced demyelinated mice by regulating monocarboxylate transporter 1
Authors: Liu Sihan , Ren Chuanlu , Qu Xuebin , Wu Xiuxiang , Dong Fuxing , Chand Yadav Kaushal , Fan Hongbin , Yao Ruiqin , Geng Deqin
Published: November 2016

Remyelination is limited in patients with multiple sclerosis (MS) due to the difficulties in recruiting proliferating oligodendrocyte precursors (OPCs), the inhibition of OPC differentiation and/or maturation, and/or failure in the generation of the myelin sheath. In vitro studies have revealed that miR‐219 is necessary for OPC differentiation and monocarboxylate transporter 1 (MCT1) plays a vital role in oligodendrocyte maturation and myelin synthesis. Herein, we hypothesized that miR‐219 might promote oligodendrocyte differentiation and attenuate demyelination in a cuprizone (CPZ)‐induced demyelinated model by regulating the expression of MCT1. We found that CPZ‐treated mice exhibited significantly increased anxiety in the open field test. However, miR‐219 reduced anxiety as shown by an increase in the total distance, the central distance and the mean amount of time spent in the central area. miR‐219 decreased the quantity of OPCs and increased the number of oligodendrocytes and the level of myelin basic protein (MBP) and cyclic nucleotide 3′ phosphodiesterase (CNP) protein. Ultrastructural studies further confirmed that the extent of demyelination was attenuated by miR‐219 overexpression. Meanwhile, miR‐219 also greatly enhanced MCT1 expression via suppression of oligodendrocyte differentiation inhibitors, Sox6 and Hes5, treatment with the MCT1 inhibitor α‐cyano‐4‐hydroxycinnamate (4‐CIN) reduced the number of oligodendrocytes and the protein levels of MBP and CNP. Taken together, these results suggest a novel mode of action of miR‐219 via MCT1 in vivo and may provide a new potential remyelination therapeutic target.
The Unique Skills and Traits of Principals in One‐Way and Two‐Way Dual Immersion Schools
Authors: Rocque Ryan , Ferrin Scott , Hite Julie M. , Randall Vance
Published: November 2016

This study considers the opinions of dual immersion elementary school principals in investigating the following research questions: (1) What do dual immersion principals identify as the skills and traits for the school leader that lead to the principal's success in a dual immersion context? and (2) What were the differences of opinion, if any, between principals of one‐way and two‐way dual immersion programs about the traits and skills required for the school leader? Data was collected from 12 interviews and an online survey of 29 principals of dual immersion schools in Utah. Dual immersion is a model for teaching foreign language in the elementary schools where two languages are studied simultaneously, thus differing from total immersion models, where the foreign language is the only language used at school (Roberts, 2015). Understanding the role of the principal at these schools was the central focus of this research. The themes and patterns that emerged from the data analysis point to five key roles for dual immersion principals. Findings also indicate that these needed skills and traits for school leaders vary between one‐way and two‐way dual immersion programs.
Water abstraction impacts stream ecosystem functioning via wetted‐channel contraction
Authors: Arroita Maite , Flores Lorea , Larrañaga Aitor , Martínez Aingeru , Martínez‐Santos Miren , Pereda Olatz , Ruiz‐Romera Estilita , Solagaistua Libe , Elosegi Arturo
Published: November 2016

Water abstraction is rapidly increasing worldwide in order to respond to escalating demands for water, food and energy. Abstraction can alter the hydrological regime of streams and rivers, reduce in‐stream habitats, change water quality and affect fluvial communities. It can also impair ecosystem functioning, although this aspect has been seldom assessed.

We experimentally tested the effect of water abstraction on stream functioning in a headwater mountain stream using a before and after control‐impact (BACI) design. We quantified changes in water physicochemical properties, biofilm biomass and activity (exo‐enzymes and metabolism), and ecosystem processes (nutrient cycling, organic matter retention and breakdown).

Water abstraction did not affect water physicochemical properties, but reduced the biomass and the alkaline phosphatase activity of biofilm per surface unit, the areal uptake of nutrients, and the travel distance of organic matter. It did not affect the biofilm metabolism and breakdown of submerged leaf litter, but decreased the total breakdown.

The impacts were larger when analysed per unit of channel length. All variables, except benthic chlorophyll‐a, were significantly reduced by abstraction, due to the contraction of the wetted channel.

The decrease in the biomass and activity of biofilm, as well as in nutrient uptake and total organic matter breakdown observed in this study could increase nutrient concentration in downstream reaches and reduce the energy transfer to higher trophic levels. Ecosystem services of permanent headwater streams are likely to be compromised with the reduction of wetted‐channel width.
Translating Delirium Prevention Strategies for Elderly Adults with Hip Fracture into Routine Clinical Care: A Pragmatic Clinical Trial
Authors: Freter Susan , Koller Katalin , Dunbar Michael , MacKnight Chris , Rockwood Kenneth
Published: November 2016

Objectives

To compare the feasibility (adherence) and effectiveness (prevalence of delirium, length of stay, mortality, discharge site) of delirium‐friendly preprinted postoperative orders (PPOs) for individuals with hip fracture, administered by regular orthopedic nurses, with routine postoperative orders.

Design

Pragmatic clinical trial to evaluate a quality improvement intervention.

Setting

Tertiary care hospital.

Participants

Individuals aged 65 and older admitted for hip fracture repair (N = 283).

Intervention

PPOs with delirium‐friendly options and doses for nighttime sedation, analgesia, and nausea and attention to catheter removal and bowel movements.

Measurements

Adherence to PPO was compared with adherence to routine orders. Drug doses were recorded. Presence of delirium was documented using the Confusion Assessment Method and the Mini‐Mental State Examination on postoperative Days 1, 3, and 5. Length of stay, discharge site, and in‐hospital mortality were recorded.

Results

Orthopedic nurses adhered reasonably well with delirium‐friendly PPOs. Of 283 participants, 42% developed postoperative delirium, with significantly less delirium in the intervention group (intervention 33%, control 51%, P = .001). The effect of the intervention was stronger in individuals with preexisting dementia (intervention 60%, control 97%, P < .001). Participants with postoperative delirium had longer hospital stays and were more likely to die or be discharged to a nursing home, but there was no significant between‐group difference in these outcomes.

Conclusion

It is possible to introduce delirium‐friendly PPOs into routine post‐hip fracture care in a representative elderly population including individuals with dementia. Delirium‐friendly PPOs executed by regular nursing staff resulted in a significant reduction in postoperative delirium but no difference in other outcomes.
Somatostatin Agonist Pasireotide Inhibits Exercise‐Stimulated Growth in the Male Siberian Hamster (Phodopus sungorus)
Authors: Dumbell R. , Petri I. , Scherbarth F. , Diedrich V. , Schmid H. A. , Steinlechner S. , Barrett P.
Published: November 2016

The Siberian hamster (Phodopus sungorus) is a seasonal mammal, exhibiting a suite of physiologically and behaviourally distinct traits dependent on the time of year and governed by changes in perceived day length (photoperiod). These attributes include significant weight loss, reduced food intake, gonadal atrophy and pelage change with short‐day photoperiod as in winter. The central mechanisms driving seasonal phenotype change during winter are mediated by a reduced availability of hypothalamic triiodothyronine (T3), although the downstream mechanisms responsible for physiological and behavioural changes are yet to be fully clarified. With access to a running wheel (RW) in short photoperiod, Siberian hamsters that have undergone photoperiod‐mediated weight loss over‐ride photoperiod‐drive for reduced body weight and regain weight similar to a hamster held in long days. These changes occur despite retaining the majority of hypothalamic gene expression profiles appropriate for short‐day hamsters. Utilising the somatostatin agonist pasireotide, we recently provided evidence for an involvement of the growth hormone (GH) axis in the seasonal regulation of bodyweight. In the present study, we employed pasireotide to test for the possible involvement of the GH axis in RW‐induced body weight regulation. Pasireotide successfully inhibited exercise‐stimulated growth in short‐day hamsters and this was accompanied by altered hypothalamic gene expression of key GH axis components. Our data provide support for an involvement of the GH axis in the RW response in Siberian hamsters.
The process and challenges of obtaining and sustaining clinical placements for nursing and allied health students
Authors: Taylor Christine , Angel Liz , Nyanga Lucy , Dickson Cathy
Published: November 2016

Aims and objectives

To describe the process and challenges from a project that aimed to develop processes, source new placements and place students primarily in the discipline of nursing, but also occupational therapy, physiotherapy, podiatry, social work, and speech therapy.

Background

Clinical experience in health facilities is an essential element of health professional education, yet globally, there is a lack of clinical placements to meet demands. Educational providers are seeking placements in nontraditional facilities, yet little has been reported on the challenges in the process of procuring clinical placements.

Design

The project used a descriptive approach within a quality implementation framework.

Methods

The project was guided by the quality implementation framework that included four critical steps: considerations of the host setting, structuring the implementation, supporting the implementation and improving future applications.

Results

A total of 115 new student placements were finalised across six health disciplines, including elderly care, nongovernment organisations and general practice. Sixty‐two nursing students were placed in the new placements during the project. Challenges included communication, the time‐consuming nature of the process and ‘gatekeeping’ blocks to obtaining placements. Recommendations included the importance of personal interaction in developing and maintaining relationships, and the need for clear communication processes and documentation. Potential areas for research are also given.

Conclusions

There is great potential for growth in establishing new placements outside the traditional placement facilities for nursing and allied health and for expanding already existing nonhospital placements.

Relevance to clinical practice

Clinical professional experiences are essential to any nursing or allied health programme. There is an increasing demand for, and global lack of, clinical placements for nursing and allied health students. The results provide nursing and allied health educators and managers a framework for planning clinical placement procurement, and assisting in decision‐making and developing strategies and processes for practice.
‘Intensive care unit survivorship’ – a constructivist grounded theory of surviving critical illness
Authors: Kean Susanne , Salisbury Lisa G , Rattray Janice , Walsh Timothy S , Huby Guro , Ramsay Pamela
Published: November 2016

Aims and objectives

To theorise intensive care unit survivorship after a critical illness based on longitudinal qualitative data.

Background

Increasingly, patients survive episodes of critical illness. However, the short‐ and long‐term impact of critical illness includes physical, psychological, social and economic challenges long after hospital discharge. An appreciation is emerging that care needs to extend beyond critical illness to enable patients to reclaim their lives postdischarge with the term ‘survivorship’ being increasingly used in this context. What constitutes critical illness survivorship has, to date, not been theoretically explored.

Design

Longitudinal qualitative and constructivist grounded theory. Interviews (n = 46) with 17 participants were conducted at four time points: (1) before discharge from hospital, (2) four to six weeks postdischarge, (3) six months and (4) 12 months postdischarge across two adult intensive care unit setting.

Method

Individual face‐to‐face interviews. Data analysis followed the principles of Charmaz's constructivist grounded theory. ‘Intensive care unit survivorship’ emerged as the core category and was theorised using concepts such as status passages, liminality and temporality to understand the various transitions participants made postcritical illness.

Findings

Intensive care unit survivorship describes the unscheduled status passage of falling critically ill and being taken to the threshold of life and the journey to a life postcritical illness. Surviving critical illness goes beyond recovery; surviving means ‘moving on’ to life postcritical illness. ‘Moving on’ incorporates a redefinition of self that incorporates any lingering intensive care unit legacies and being in control of one's life again.

Relevance to clinical practice

For healthcare professionals and policymakers, it is important to realise that recovery and transitioning through to survivorship happen within an individual's time frame, not a schedule imposed by the healthcare system. Currently, there are no care pathways or policies in place for critical illness survivors that would support intensive care unit survivors and their families in the transitions to survivorship.
Growth of nurse prescribing competence: facilitators and barriers during education
Authors: Hopia Hanna , Karhunen Anne , Heikkilä Johanna
Published: November 2016

Aims and objectives

To describe facilitators and barriers in relation to the growth of nurse prescribing competence from the perspective of the nurses studying in a prescribing programme.

Background

The number of nurses enrolled in a nurse prescribing programme is rapidly increasing in Finland. However, few studies on nurse prescribing education are available and therefore research is needed, particularly from the point of view of nurses studying in the programme.

Design

The descriptive, qualitative study used the text of student online learning diaries as data during a 14‐month prescribing programme. The sample consisted of 31 nurses, public health nurses or midwives enrolled in a prescribing programme at a university of applied sciences. The data were analysed using the inductive analysis method.

Results

The growth of nurses’ prescribing competence was facilitated by learning clinical examination of the patient, networking with peers, receiving support from the workplace and supervisors, doctors’ positive attitude towards nurse prescribing and being able to apply competencies directly to nursing practice. The barriers to the growth of nurses’ prescribing competence were unclear job description, incomplete care plans and concerns about how consultation with doctors will be organised and realised.

Conclusions

The results show that, for the purpose of developing the new role and position of nurse prescribers, educators and nursing managers must invest more in staff awareness of nurse prescribing education and also offer more support to nurse prescribers in their workplaces.

Relevance to clinical practice

The results of this study can be used especially in countries where nurse prescribing education is only in the process of being planned or has just been started. Heads of nursing and educators in prescribing education will benefit from the results when creating expanded job descriptions for nurses and supporting networking between students during the period of training.
Supplementation of distiller's grains during late gestation in beef cows consuming low‐quality forage decreases uterine, but not mammary, blood flow
Authors: Mordhorst B. R. , Zimprich C. A. , Camacho L. E. , Bauer M. L. , Vonnahme K. A.
Published: November 2016

Positive effects have been observed in offspring from beef cows supplemented with corn dried distillers grain with solubles (DDGS) during late gestation. The hypothesis of this study was that late gestational DDGS supplementation to beef cows would increase blood flow (BF) to the gravid uterus and mammary gland thus impacting birthweight and post‐natal growth of the offspring. Experiment 1 investigated mammary gland BF in multiparous cows during late pregnancy. Beef cows were fed a control (CON1) diet of low‐quality hay (n = 5) or a supplement diet (SUP1) of low‐quality hay with DDGS [1.7 g/kg of body weight (BW); n = 6]. In Experiment 2, multiparous late pregnant beef cows were fed either a control (CON2) diet of a low‐quality hay (n = 4) or a supplement diet (SUP2) of low‐quality hay with DDGS (1.7 g/kg of BW; n = 5). Uterine and mammary gland BF were recorded every 21 days during late gestation. In Experiment 1, there were no effects of diet or day on mammary gland hemodynamics. In Experiment 2, total and ipsilateral uterine BF was less (p ≤ 0.04) in SUP2 vs. CON2 cows and similar BF to contralateral horns. Mammary gland BF was unaltered by maternal supplementation. Even when measured in two different years in two different environments, mammary gland BF remained unaltered to DDGS supplementation. Investigations on the mechanism that may impact uterine BF during late gestation remain to be known.
Tort tactics: an empirical study of personal injury litigation strategies
Authors: Lewis Richard
Published: November 2016

This paper reveals some of the tactics that lawyers may use when conducting personal injury litigation. The research is empirically based by being drawn from structured interviews with a cross-section of practitioners. This qualitative evidence helps to place the rules of tort in a wider context and suggests that tactical considerations may affect the outcome of individual cases irrespective of their legal merits. A range of strategies are considered here to illustrate how they may be used at different points during the litigation. In addition, the paper updates our understanding of the compensation system by considering the practitioners' responses in the light of the major changes made to this area of practice in recent years. It reveals how negotiation tactics have developed since research in this area was last carried out. Overall, the paper adds to a very limited literature dealing with negotiation and settlement of personal injury claims in the UK.
Sleep–Wake Cycle, Daytime Sleepiness, and Attention Components in Children Attending Preschool in the Morning and Afternoon Shifts
Authors: Belísio Aline S. , Kolodiuk Fernanda F. , Louzada Fernando M. , Valdez Pablo , Azevedo Carolina V. M.
Published: November 2016

Children tend to sleep and wake up early and to exhibit daytime sleep episodes. To evaluate the impact of school start times on sleepiness and attention in preschool children, this study compared the temporal patterns of sleep, daytime sleepiness, and the components of attention between children aged 4–6 years that study in the morning (n = 66) and the afternoon (n = 144) shifts. The former get up 1 hr and 30 min earlier on weekdays and show lower efficiency on the sustained attention task than those who study in the afternoon. Thus, the morning shift was associated with a reduction in nighttime sleep, which might have a negative effect on children's performance in the morning, causing higher levels of daytime sleepiness and a decline in sustained attention. Because only one parameter of one component of attention was negatively affected, further studies are needed to confirm this effect on cognition.
Training physicians for the real world of medicine: administration‐based learning
Authors: Rosenstock Jason , Sparks Garrett M
Published: November 2016

Tired of outdated teaching formats like case‐based learning (CBL), problem‐based learning (PBL) and team‐based learning (TBL)? We wanted something fresh for our medical school, something that would prepare our graduates for the modern practice of medicine, something that would satisfy regulatory agencies and our deans. After doing an extensive needs assessment, which we ignored, we decided to replace basic science in our curriculum with something more practical: administration‐based learning (ABL). We taught students how to fix fax machines, how to deal with angry team members, and how to maximise revenue in private practice – lessons that were well received and were more consistent with what physicians really need to learn to be effective practitioners. Educational outcomes have been positive, and although more research is needed, we call on other schools to add ABL tracks to their own curricula.
WATCH Scrubs: a video observational study of workplace‐based learning at Sacred Heart Hospital
Authors: Rees Eliot L , Sinha Yashashwi , Davies Benjamin , J Quinn Patrick
Published: November 2016

Context

Workplace‐based learning remains the cornerstone of clinical training. Teaching in the clinical environment promotes active engagement as trainees are required to combine their competencies (e.g. skills in history taking, examination and clinical reasoning) to determine an appropriate course of action. High‐quality clinical teaching supports and scaffolds trainees’ learning in clinical workplaces.

Objectives

This study aimed to explore the quality of clinical teaching at a large teaching hospital.

Methods

A retrospective video observational study of 9 years of workplace‐based learning at Sacred Heart Hospital, a large private teaching hospital, was conducted. Each academic year was observed by one researcher. Clinical teaching encounters were identified and analysed using the Warwick Assessment insTrument for Clinical teacHing (WATCH). Descriptive observation notes were recorded and analysed thematically.

Results

A total of 131 teaching encounters provided by 12 tutors were identified. The 15‐item instrument demonstrated a Cronbach's alpha of 0.89. The hidden curriculum, role modelling and reflection played prominent roles in trainees’ personal and professional development.

Conclusions

Trainees’ learning in clinical workplaces extends beyond the formal teaching they receive to include the development of professional behaviours through role modelling and reflection on clinical encounters.
Does your pig go ‘knor’? Medical students’ skills in using animal sounds as a cross‐cultural paediatric engagement tool
Authors: Cornwall Jon , Roy Melyssa
Published: November 2016

The development of verbal communication skills is an important aspect of medical education as accurate assessment in part relies on effectively obtaining information from patients. When assessing children of different cultural or ethnic backgrounds, young medics may find effective verbal communication difficult because they lack understanding about what children are really like. Animal noises are a likely tool with which to successfully engage with young children. However, these differ by culture and it is unclear whether young New Zealand medical students will be adept at effectively engaging and communicating with foreign children via this mode of communication. We therefore assessed whether medical students in our country were able to accurately reproduce animal noises from different cultures. Six current medical students from New Zealand (with English as their first language) were assessed on their ability to reproduce animal noises from three different foreign languages: Dutch, Arabic and Danish. The animals selected were duck, cow, dog, frog, pig and sheep. Students were played recordings of the foreign‐language animal noises, and were then rated on a scale of 1–5 (1 = poor, 5 = outstanding) on their ability to reproduce the noise. Arabic animal noises were reproduced more convincingly than those in the other languages (mean score: 3.8), of which animal noises in Danish were worst (mean score: 3.1). Perhaps unsurprisingly, sheep noises were reproduced best (mean score: 4.7), whereas pig noises were the least convincing (mean score: 2.2). Findings indicate that New Zealand medical students are likely to be better than average at reproducing animal noises in the languages examined, and are perhaps socially and genetically predisposed to replicating sheep noises successfully. They are therefore likely to make good paediatric registrars and fabulous au pairs. The study highlights the more serious issues of multicultural understanding and tolerance of other cultures, and provides a novel paediatric engagement tool for those young medics who do not really ‘get’ children.
Is the long case dead? ‘Uh, I don't think so’: the Uh/Um Index
Authors: Duvivier Robbert , Veysey Martin
Published: November 2016

Current tools for clinical assessment are tedious and time‐consuming, particularly the dreadful long case. There is a need for novel instruments that incorporate other aspects of competence. We propose such a method, namely the Uh/Um Index. Our innovation paper describes the rationale for using speech dysfluency and occurrences of filler words such as ‘uh’ and ‘um’ as a proxy for competence. This appears to have won initial support from senior clinicians in our institution. Additional research is needed (non‐restricted grants are welcomed) to establish rigorous standard setting and to fund our attendance at overseas conferences to make the Uh/Um Index the new buzzword in medical education.
The Cross‐Canada Quintet presents variations on music: movements in the keys of H, P and E
Authors: Schrewe Brett , Bates Joanna , Watling Christopher , Ellaway Rachel H , Pratt Dan
Published: November 2016

Whether it is rock playing in the background during a surgery, cool jazz that wafts from our office computer speakers as we write up our clinical notes, or the soaring of a symphony on the radio that inspires that perfect flourish to an article, music is woven throughout much of our clinical and academic lives. For the five of us, however, music alternates between the background and foreground in our lives as health professions educators. Music balances the working day, illuminates our research, and reconciles the utility of our training with the originality of our practice. We invite you to discover the interplays, dissonances and harmonies inspired by and reflected in this leitmotif. Pull up a chair, sit back, put on one of your own favourite pieces and explore these ideas as we riff and rhapsodise on variations on this theme.
Learning the hard way: 10 lessons for developing undergraduate curricula
Authors: Jacob Hannah , Fertleman Caroline R
Published: November 2016

The present study outlines key learning points derived from 2 years spent developing a national undergraduate curriculum for child health. Findings are sourced from analyses of a series of semi‐structured musings by beleaguered educationalists and may serve to reassure others engaged in developing undergraduate curricula that it is possible to survive the process and even to produce something quite good. The authors’ best advice is to do it, but don't say we didn't warn you.
And you try and tell the medical students of today that… and they won't believe ya
Authors: Harris Benjamin H L , Wilson David J
Published: November 2016

Older clinicians typically engage in reflections on their own early careers and indeed whichever generation of clinician you talk to, their medical school and early career experiences were more challenging than the last. We draw on inspiration from Monty Python and specifically the Four Yorkshiremen to illustrate this point. However, as we strive to lay the foundations of learning that avoids the adage ‘whatever doesn't kill you, makes you stronger’, we must remember that medics are competitive… even at complaining.
What's in a name? Word inflation, punctuation, abbreviation and cloud formation
Authors: Schofield Susie J , Schofield Pieta G
Published: November 2016

The title of a journal paper offers a crucial portal into any scientific field. It determines whether interested readers locate the paper and whether others have enough interest sparked to lead them to read the abstract. This article looks at authored journal paper titles in Medical Education over its first 50 years (n = 6357) of publication and Medical Teacher over its first 35 years of publication, revealing both trends in areas of interest and how those interests are worded. Word clouds per decade showed a shift from teaching to learning and from examination to assessment, and new foci on learning, patients, research and feedback in both journals. The average length of title in Medical Education peeked in the 2000s, dropping to 70 characters in the 2010s, with no titles being longer than 140 characters (the length of a tweet) in this last decade. Abbreviations were used sparingly. The use of humorous titles, although not common, has increased in recent years. The use of the colon showed a marked increase in the 1980s, dropping a little in the 2000s but resurging in the 2010s. Titles posed as a question increased steadily, appearing to plateau in the 2000s at 11%. The use of humour and questions suggests that the authors of these articles are submitting papers to be selected by the human rather than just the virtual eye. We also hypothesise that the use of humour may indicate a maturation of medical education as a subject.
Validation of a screening questionnaire for X‐linked dystonia parkinsonism: The first phase of the population‐based prevalence study of X‐linked dystonia parkinsonism in Panay
Authors: Diestro Jose Danilo B , Pasco Paul Matthew D , Lee Lillian V ,   the XDP Study Group of the Philippine Children's Medical Center
Published: November 2016

Background

The current prevalence of X‐linked dystonia parkinsonism is not known. No screening tool for the condition exists. By developing a screening questionnaire, the present study is intended to be the first step in identifying the prevalence of the disease.

Aim

To develop and validate a simple, easy to use, community‐based, screening questionnaire for the diagnosis of X‐linked dystonia parkinsonism.

Methods

Community health workers administered an 11‐item yes/no questionnaire in the native Panay island language to 54 genetically‐confirmed X‐linked dystonia parkinsonism patients and 54 healthy controls from the island of Panay. The questionnaire is made up of elements from existing questionnaires on Parkinson's disease and dystonia, and known clinical features of the disease. The participants were partitioned into training (n = 88) and test (n = 20) datasets. To select which items were predictive of X‐linked dystonia parkinsonism, the Clinical Utility Index of each item was determined. Afterwards, multivariable binary logistic regression was done to build a predictive model that was run on the test dataset.

Results

Four items on “sustained twisting,” “jaw opening and closing,” “slowness in movement” and “shuffling steps” were found to be the most predictive of X‐linked dystonia parkinsonism. All had at least a “good” Clinical Utility Index. The questions showed 100% sensitivity and 90% specificity (95% CI 65.6–100%) in identifying cases.

Conclusions

The resulting four‐item questionnaire was found to be predictive of X‐linked dystonia parkinsonism. The screening instrument can be used to screen for X‐linked dystonia parkinsonism in a prevalence study.