bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in residents’ opportunities for experiential learning over time
Authors: Peets Adam D , Stelfox Henry T 
Published: November 2012

Medical Education 2012: 46: 1189–1193Context  Learning in the clinical environment is believed to be a crucial component of residency training. However, it remains unclear whether recent changes to postgraduate medical education, including the implementation of work hour limitations, have significantly impacted opportunities for experiential learning. Therefore, we sought to quantify opportunities to gain clinical experience within medical‐surgical intensive care units (ICUs) over time.Methods  Data on the numbers of patients admitted and invasive procedures performed per day between 1 July 2001 and 30 June 2010 within three academic medical‐surgical ICUs in Calgary, Alberta, Canada were obtained from electronic medical records. These data were matched to resident doctor on‐call schedules and residents’ opportunities to admit patients and participate in procedures were calculated and compared over time using Spearman’s rho.Results  We found that over a 9‐year period, the opportunities afforded to residents (n = 1156) to admit patients (n = 17 189) and perform procedures (n = 52 827) during ICU rotations decreased by 32% (p < 0.001) and 34% (p < 0.001), respectively.Conclusions  Our results suggest that there has been a significant decrease in residents’ clinical experiences in the ICU over time. Further investigations to better understand these changes and how they may impact on performance as residents become independent practising doctors are warranted.
How core competencies are taught during clinical supervision: participatory action research in family medicine
Authors: Saucier Danielle , Paré Line , Côté Luc , Baillargeon Lucie 
Published: November 2012

Medical Education 2012: 46: 1194–1205Objectives  The development of professional competence is the main goal of residency training. Clinical supervision is the most commonly used teaching and learning method for the development of core competencies (CCs). The literature provides little information on how to encourage the learning of CCs through supervision. We undertook an exploratory study to describe if and how CCs were addressed during supervision in a family medicine residency programme.Methods  We selected a participatory action research design to engage participants in exploring their precepting practices. Eleven volunteer faculty staff and six residents from a large family medicine residency programme took part in a 9‐month process which included three focus group encounters alternating with data gathering during supervision. We used mostly qualitative methods for data collection and analysis, with thematic content analysis, triangulation of sources and of researchers, and member checking.Results  Participants realised that they addressed all CCs listed as programme outcomes during clinical supervision, albeit implicitly and intuitively, and often unconsciously and superficially. We identified a series of factors that influenced the discussion of CCs: (i) CCs must be both known and valued; (ii) discussion of CCs occurs in a constant adaptation to numerous contextual factors, such as residents’ characteristics; (iii) the teaching and learning of CCs is influenced by six challenges in the preceptor–resident interaction, such as residents’ active engagement, and (iv) coherence with other curricular elements contributes to learning about CCs. Differences between residents’ and preceptors’ perspectives are discussed.Conclusions  This is the first descriptive study focusing on the teaching of CCs during clinical supervision, as experienced in a family medicine residency programme. Content and process issues were equally influential on the discussion of CCs. Our findings led to a representation of factors determining the teaching and learning of CCs in supervision, and suggest directions for research, for faculty development, and for interventions with learners.
Mapping as a learning strategy in health professions education: a critical analysis
Authors: Pudelko Beatrice , Young Meredith , Vincent‐Lamarre Philippe , Charlin Bernard 
Published: November 2012

Medical Education 2012: 46: 1215–1225Context  Mapping is a means of representing knowledge in a visual network and is becoming more commonly used as a learning strategy in medical education. The assumption driving the development and use of concept mapping is that it supports and furthers meaningful learning.Objectives  The goal of this paper was to examine the effectiveness of concept mapping as a learning strategy in health professions education.Methods  The authors conducted a critical analysis of recent literature on the use of concept mapping as a learning strategy in the area of health professions education.Results  Among the 65 studies identified, 63% were classified as empirical work, the majority (76%) of which used pre‐experimental designs. Only 24% of empirical studies assessed the impact of mapping on meaningful learning. Results of the analysis do not support the hypothesis that mapping per se furthers and supports meaningful learning, memorisation or factual recall. When documented improvements in learning were found, they often occurred when mapping was used in concert with other strategies, such as collaborative learning or instructor modelling, scaffolding and feedback.Conclusions  Current empirical research on mapping as a learning strategy presents methodological shortcomings that limit its internal and external validity. The results of our analysis indicate that mapping strategies that make use of feedback and scaffolding have beneficial effects on learning. Accordingly, we see a need to expand the process of reflection on the characteristics of representational guidance as it is provided by mapping techniques and tools based on field of knowledge, instructional objectives, and the characteristics of learners in health professions education.
Power, leadership and transformation: the doctor’s potential for influence
Authors: Gabel Stewart 
Published: November 2012

Medical Education 2012: 46: 1152–1160Context  Power and leadership are concepts that are linked. Both are studied too infrequently in medical and health care settings, given the responsibilities and opportunities doctors and other health care personnel have to exert leadership and power appropriately to foster patient‐centred and health care organisational goals.Methods  This paper reviews Raven’s concept of power, clarifies the bases of power that are available to doctors in different roles and provides illustrations of the application of the bases of power in medical practice. The relationship between power and leadership is explored, with an emphasis on how power and leadership are linked through the personal characteristics and competencies of the leader.Results  Transformational leadership illustrates the incorporation and elaboration of power strategies into a principles‐driven, relationship‐oriented and empirically grounded form of leadership. Illustrations of the appropriate and inappropriate use of power and leadership in health care settings are provided.Conclusions  The study of power, the study of leadership and their linkage should be incorporated to a greater degree into medical education at all levels. Strategies to achieve this end are suggested.
Development of knowledge in basic sciences: a comparison of two medical curricula
Authors: Nouns Zineb , Schauber Stefan , Witt Claudia , Kingreen Halina , Schüttpelz‐Brauns Katrin 
Published: November 2012

Medical Education 2012: 46: 1206–1214Context  Basic medical sciences education differs among medicine courses, especially as traditional and integrated problem‐based learning (PBL) curricula teach basic sciences in very different ways. The literature shows no clear differences in the performance of students of these different educational philosophies. The Charité Medical University of Berlin (Charité Universitätsmedizin Berlin) teaches both a traditional medical curriculum (TMC) and a PBL reformed medical curriculum (RMC). Both curricula conduct the Progress Test in Medicine (PTM), which examines competence in the basic and clinical sciences from the first to the last semester.Objectives  The aim of this study was to compare the development and retention of knowledge in the basic medical sciences between students on the traditional and reformed undergraduate medical curricula, respectively.Methods  For each student and single PTM, relative frequencies of correct answers were computed for basic sciences items only and for the whole curriculum. Frequencies were averaged and grouped by semester and curriculum. Analyses of variance (anovas) were performed at all measurement points with a Bonferroni‐corrected p‐value at the level of p < 0.005. Eta‐squared (η2) was used to classify effect size.Results  In the first three semesters, RMC students slightly outperform TMC students in the basic sciences, although TMC students receive more systematic teaching. After this, TMC students develop a peak of knowledge in basic sciences and overtake RMC students. The knowledge of TMC students then decreases over time, but despite this, they perform better in the final semester. Students on the RMC show constant progress throughout their undergraduate studies. Overall, the development of medical knowledge is consistent in both curricula. There is no significant difference in this outcome between the traditional and PBL courses.Conclusions  Progress testing as a longitudinal method allows us to better understand the development of knowledge during formal undergraduate education. The main difference between traditional and problem‐based medical education seems to be provoked by the high‐stakes national examination undertaken in the traditional course (the Physikum).
Waking up the next morning: surgeons’ emotional reactions to adverse events
Authors: Luu Shelly , Patel Priyanka , St‐Martin Laurent , Leung Annie SO , Regehr Glenn , Murnaghan M Lucas , Gallinger Steven , Moulton Carol‐anne 
Published: November 2012

Medical Education 2012: 46: 1179–1188Context  The adverse patient event is an inherent component of surgical practice, but many surgeons are unprepared for the profound emotional responses these events can evoke. This study explored surgeons’ reactions to adverse events and their impact on subsequent judgement and decision making.Methods  Using a constructivist grounded theory approach, we conducted 20 semi‐structured, 60‐minute interviews with surgeons across subspecialties, experience levels, and sexes to explore surgeons’ recollections of reactions to adverse events. Further interviews were conducted with six general surgeons to explore more immediate reactions after 28 adverse events. Data coding was both inductive, developing a new framework based on emergent themes, and deductive, using an existing framework for care providers’ reactions to adverse events.Results  Surgeons expressed feeling unique and alone in the depths of their reactions to adverse events and consistently described four phases of response, each containing cognitive and emotive components, following such events. The initial phase (the kick) involved feelings of failure (‘Am I good enough?’) experienced with a significant physiological response. This was shortly followed by a second phase (the fall), during which the surgeon experienced a sense of chaos and assessed the extent of his or her contribution to the event (‘Was it my fault?’). During the third phase (the recovery), the surgeon reflected on the adverse event (‘What can I learn?’) and experienced a sense of ‘moving on’. In the fourth phase (the long‐term impact), the surgeon experienced the prolonged and cumulative effects of these reactions on his or her own personal and professional identities. Surgeons also described an effect on their clinical judgement, both for the case in question (minimisation) and future cases (overcompensation).Conclusions  Surgeons progress through a series of four phases following adverse events that are potentially caused by or directly linked to surgeon error. The framework provided by this study has implications for teaching, surgeon wellness and surgeon error.
Mutational analysis of MukE reveals its role in focal subcellular localization of MukBEF
Authors: She Weifeng , Mordukhova Elena , Zhao Hang , Petrushenko Zoya M. , Rybenkov Valentin V. 
Published: November 2012

SummaryBacterial condensin MukBEF is essential for global folding of the Escherichia coli chromosome. MukB, a SMC (structural maintenance of chromosome) protein, comprises the core of this complex and is responsible for its ATP‐modulated DNA binding and reshaping activities. MukF serves as a kleisin that modulates MukB–DNA interactions and links MukBs into macromolecular assemblies. Little is known about the function of MukE. Using random mutagenesis, we generated six loss‐of‐function point mutations in MukE. The surface mutations clustered in two places. One of them was at or close to the interface with MukF while the other was away from the known interactions of the protein. All loss‐of‐function mutations affected focal localization of MukBEF in live cells. In vitro, however, only some of them interfered with the assembly of MukBEF into a complex or the ability of MukEF to disrupt MukB–DNA interactions. Moreover, some MukE mutants were able to join intracellular foci formed by endogenous MukBEF and most of the mutants were efficiently incorporated into MukBEF even in the presence of endogenous MukE. These data reveal that focal localization of MukBEF involves other activities besides DNA binding and that MukE plays a central role in them.
Role of iron homeostasis in the virulence of phytopathogenic bacteria: an ‘à la carte’ menu
Authors: Franza Thierry , Expert Dominique 
Published: November 2012

SummaryThe interaction between pathogenic microbes and their hosts is determined by survival strategies on both sides. As a result of its redox properties, iron is vital for the growth and proliferation of nearly all organisms, including pathogenic bacteria. In bacteria–vertebrate interactions, competition for this essential metal is critical for the outcome of the infection. The role of iron in the virulence of plant pathogenic bacteria has only been explored in a few pathosystems in the past. However, in the last 5 years, intensive research has provided new insights into the mechanisms of iron homeostasis in phytopathogenic bacteria that are involved in virulence. This review, which includes important plant pathosystems, discusses the recent advances in the understanding of iron transport and homeostasis during plant pathogenesis. By summarizing the recent progress, we wish to provide an updated view clarifying the various roles played by this metal in the virulence of bacterial phytopathogens as a nutritional and regulatory element. The complex intertwining of iron metabolism and oxidative stress during infection is emphasized.
Posaconazole after previous antifungal therapy with voriconazole for therapy of invasive aspergillus disease, a retrospective analysis
Authors: Heinz Werner J. , Egerer Gerlinde , Lellek Heinrich , Boehme Angelika , Greiner Jochen 
Published: November 2012

SummaryInvasive aspergillosis is an important cause of morbidity and mortality in haematological patients. Current guidelines recommend voriconazole as first‐line therapy. A change in class of antifungal agent is generally recommended for salvage therapy. The focus of this analysis was to assess if posaconazole is suitable for salvage therapy following voriconazole treatment. This was a retrospective investigation on patients with sequential antifungal therapy of posaconazole after voriconazole identified at four German hospitals. Response rates at 30 and 60 days following start of posaconazole application and toxicity of azoles by comparing liver enzymes and cholestasis parameters were evaluated. Data were analysed by descriptive statistics. Overall, the success rate was 72.2% [15 of 36 patients showed complete response (41.7%), 11 patients partial response (30.6%) at any time point], eight patients failed treatment and two were not evaluable. Mean laboratory values increased during voriconazole and decreased during posaconazole treatment: aspartate aminotransferase (increase: 31.9 U l−1 vs. decrease: 19.6 U l−1), alanine aminotransferase (32.4 U l−1 vs. 19.8 U l−1), gamma‐glutamyl transferase (124.2 U l−1 vs. 152.3 U l−1) and alkaline phosphatase (71.5 U l−1 vs. 40.3 U l−1) respectively. No patient discontinued posaconazole therapy due to an adverse event. In this analysis posaconazole was a safe and effective antifungal salvage therapy in patients with prior administration of another triazole.
National identity during periods of controversy: celebrating Cinco de Mayo in Phoenix, Arizona
Authors: Kaftan Joanna 
Published: November 2012

AbstractCinco de Mayo, celebrated by Mexican Americans as well as Americans of other ethnicities, provides an opportunity to examine the influence of ethnic festivals on broader US identity. Given the recent controversy over the immigration bill, State Bill 1070, passed in Arizona in 2010, the themes presented in newspaper articles concerning the celebration of the holiday in Phoenix, Arizona (2006–11) and the public response to these articles are examined. This examination reveals the intense contestation associated with the presentation of symbols and themes of national identity during periods of political controversy. It also illustrates that ordinary people have strong, long‐standing opinions about the future of the nation and national identity and will express their opinions when an outlet is provided to them
Visceral and somatic sensory function in functional dyspepsia
Authors: Li X. , Cao Y , Wong R. K. M , Ho K. Y , Wilder‐Smith C. H 
Published: November 2012

AbstractBackground  Visceral hypersensitivity is one of the proposed underlying mechanisms in functional dyspepsia (FD). It is not clear whether visceral hypersensitivity in FD is a manifestation of a central sensitization also encompassing somatic sensitization. Transient receptor potential vanilloid‐1 (TRPV1) pathways are involved in gastric mechanosensory physiology and the TRPV1 receptor agonist, capsaicin, has been used as a chemical stimulant.Methods  In this double‐blind, randomized study we evaluated both visceral and somatic sensory function in 34 FD patients and 42 healthy controls using quantitative sensory testing. Visceral pain sensitivity was assessed using a validated gastric pain model with oral capsaicin capsule titration and somatic pain sensitivity was determined by foot heat and hand electric stimulation.Key Results  The median capsaicin dose required to attain moderate pain was 0.5mg in FD and 1mg in controls (P = 0.03). At these doses, mean pain intensities on a 0–100 visual analog scale were greater for FD than controls [56.9 (95% confidence intervals, 52.2–61.5) vs 45.1 (41.6–48.6), resp.] (P = 0.005). Overall, mean somatic sensory and pain thresholds were similar in FD and control groups, but in a subgroup of FD pain hypersensitivity was seen on the hand and on the foot at different stimulation thresholds.Conclusions & Inferences  A majority of patients with FD have visceral chemo‐hypersensitivity involving TRPV1 pathways. A substantial subgroup also has somatic hypersensitivity as evidence of central sensitization.
Four 13‐lipoxygenases contribute to rapid jasmonate synthesis in wounded Arabidopsis thaliana leaves: a role for lipoxygenase 6 in responses to long‐distance wound signals
Authors: Chauvin Adeline , Caldelari Daniela , Wolfender Jean‐Luc , Farmer Edward E. 
Published: November 2012

Summary

Damage‐inducible defenses in plants are controlled in part by jasmonates, fatty acid‐derived regulators that start to accumulate within 30 s of wounding a leaf.

Using liquid chromatography–tandem mass spectrometry, we sought to identify the 13‐lipoxygenases (13‐LOXs) that initiate wound‐induced jasmonate synthesis within a 190‐s timeframe in Arabidopsis thaliana in 19 single, double, triple and quadruple mutant combinations derived from the four 13‐LOX genes in this plant.

All four 13‐LOXs were found to contribute to jasmonate synthesis in wounded leaves: among them LOX6 showed a unique behavior. The relative contribution of LOX6 to jasmonate synthesis increased with distance from a leaf tip wound, and LOX6 was the only 13‐LOX necessary for the initiation of early jasmonate synthesis in leaves distal to the wounded leaf.

Herbivory assays that compared Spodoptera littoralis feeding on the lox2‐1 lox3B lox4A lox6A quadruple mutant and the lox2‐1 lox3B lox4A triple mutant revealed a role for LOX6 in defense of the shoot apical meristem. Consistent with this, we found that LOX6 promoter activity was strong in the apical region of rosettes. The LOX6 promoter was active in and near developing xylem cells and in expression domains we term subtrichomal mounds.
Elevated CO2 does not offset greater water stress predicted under climate change for native and exotic riparian plants
Authors: Perry Laura G. , Shafroth Patrick B. , Blumenthal Dana M. , Morgan Jack A. , LeCain Daniel R. 
Published: November 2012

Summary

In semiarid western North American riparian ecosystems, increased drought and lower streamflows under climate change may reduce plant growth and recruitment, and favor drought‐tolerant exotic species over mesic native species. We tested whether elevated atmospheric CO2 might ameliorate these effects by improving plant water‐use efficiency.

We examined the effects of CO2 and water availability on seedlings of two native (Populus deltoides spp. monilifera, Salix exigua) and three exotic (Elaeagnus angustifolia, Tamarix spp., Ulmus pumila) western North American riparian species in a CO2‐controlled glasshouse, using 1‐m‐deep pots with different water‐table decline rates.

Low water availability reduced seedling biomass by 70–97%, and hindered the native species more than the exotics. Elevated CO2 increased biomass by 15%, with similar effects on natives and exotics. Elevated CO2 increased intrinsic water‐use efficiency (Δ13Cleaf), but did not increase biomass more in drier treatments than wetter treatments.

The moderate positive effects of elevated CO2 on riparian seedlings are unlikely to counteract the large negative effects of increased aridity projected under climate change. Our results suggest that increased aridity will reduce riparian seedling growth despite elevated CO2, and will reduce growth more for native Salix and Populus than for drought‐tolerant exotic species.
The possibility of regulating for obesity prevention–understanding regulation in theCommonwealthGovernment
Authors: Crammond B. , Van C. , Allender S. , Peeters A. , Lawrence M. , Sacks G. , Mavoa H. , Swinburn B. A. , Loff B. 
Published: November 2012

SummaryA complex regulatory package is likely to be necessary to effectively reduce obesity prevalence in developed countries. This study investigated the barriers and facilitators to implementing regulatory interventions to prevent obesity within the executive arm of theAustralianCommonwealthGovernment. Policy reviews were conducted on nine government departments to understand their roles and interests in obesity. From this process we identified regulatory review carried out by theOffice ofBestPracticeRegulation as possibly posing a barrier to law reform for obesity prevention, along with the complexity of the food policymaking structures. The policy reviews informed subsequent in‐depth semi‐structured interviews with seniorCommonwealth government officers (n = 13) focused on refining our understanding of the barriers to enacting obesity prevention policy. In addition to the two barriers already identified, interviewees identified a lack of evidence for interventions, which would reduce obesity prevalence, and the influence of politicians on executive decisions as posing obstacles. Most interviewees believed that the barriers to regulating to prevent obesity were strong and that intervention by elected politicians would be the most likely method of implementing obesity prevention policy.