bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contextualizing SEGUE: Evaluating Residents' Communication Skills Within the Framework of a Structured Medical Interview
Authors: Skillings Jared Lyon , Porcerelli John H. , Markova Tsveti 
Published: March 2010

Abstract

Background
The SEGUE (Set the stage, Elicit information, Give information, Understand the patient's perspective, and End the encounter) Framework is a checklist-style rating scale to facilitate the teaching and assessment of communication skills in medical learners. It has been used for over 15 years, and it is recommended in the Accreditation Council for Graduate Medical Education toolbox of assessment methods for resident training. When it was developed, its ability to provide objective scoring was a substantial improvement over global ratings.

Methods
In this article we describe the strengths and weaknesses of the SEGUE Framework. We highlight one residency program's experience with using the SEGUE Framework to evaluate residents' communication skills. Specifically, we cite previous studies and describe our own analysis of resident interviewing performance that demonstrates how the SEGUE Framework did not distinguish between different levels of interviewing skill level in our sample.

Results
Two case examples illustrate how the SEGUE Framework is not an ideal instrument to measure either the quality or the process of medical interviews.

Conclusion
Therefore, we propose a new method of contextualized assessment that builds on the SEGUE Framework. Our system evaluates discrete interviewing behaviors within the context of an ambulatory medical interview. We describe our interview structure, as well as a new instrument (the Wy-Mii, pronounced “why me”), to assess both communication and interpersonal skills. We expect that our new method of contextualized assessment will better differentiate between beginning and advanced levels of medical interviewing skills for residents.
Using the American Board of Internal Medicine Practice Improvement Modules to Teach Internal Medicine Residents Practice Improvement
Authors: Shunk Rebecca , Dulay Maya , Julian Kathy , Cornett Patricia , Kohlwes Jeffrey , Tarter Laura , Hollander Harry , O'Brien Bridget , O'Sullivan Patricia 
Published: March 2010

Abstract

Background
Although residency programs must prepare physicians who can analyze and improve their practice, practice improvement (PI) is new for many faculty preceptors. We describe the pilot of a PI curriculum incorporating a practice improvement module (PIM) from the American Board of Internal Medicine for residents and their faculty preceptors.

Methods
Residents attended PI didactics and completed a PIM during continuity clinic and outpatient months working in groups under committed faculty.

Results
All residents participated in PI group projects. Residents agreed or strongly agreed that the projects and the curriculum benefited their learning and patient care. A self-assessment revealed significant improvement in PI competencies, but residents were just reaching a “somewhat confident” level.

Conclusion
A PI curriculum incorporating PIMs is an effective way to teach PI to both residents and faculty preceptors. We recommend the team approach and use of the PIM tutorial approach especially for faculty.
Patient-Centered Collaborative Care: The Impact of a New Approach to Postpartum Rounds on Residents' Perception of Their Work Environment
Authors: Baldwin Maureen , Hashima Jason , Guise Jeanne-Marie , Gregory William Thomas , Edelman Alison , Segel Sally 
Published: March 2010

Abstract

Objective
At our institution, traditional postpartum rounds consisted of separate visits from all members of the obstetric team. This led to patient care inefficiencies and miscommunication. In an effort to improve patient care, patient-centered collaborative care (PCCC) was established, whereby physicians, residents, medical students, nurses, case managers, and social workers conduct rounds as a team. The goal of this observational study was to evaluate how PCCC rounds affected resident physicians' assessment of their work environment.

Methods
Obstetrics and gynecology residents completed a 13-question written survey designed to assess their sense of workflow, education, and workplace cohesion. Surveys were completed before and 6 months after the implementation of PCCC. Responses were compared in aggregate for preintervention and postintervention with Pearson χ2 test.

Results
Ninety-two percent of the obstetrics residents (n  =  23) completed the preintervention survey, and 79% (n  =  19) completed the postintervention survey. For most measures, there was no difference in resident perception between the 2 time points. After implementation of PCCC rounds, fewer residents felt that rounds were educational (preintervention  =  39%, postintervention  =  7%; P  =  .03).

Conclusion
Residents did not report negative impacts on workflow, cohesion, or general well-being after the implementation of PCCC rounds. However, there was a perception that PCCC rounds negatively impacted the educational value of postpartum rounds. This information will help identify ways to improve the resident physician experience in the obstetric service while optimizing patient care.
On-site Night Float by Attending Physicians: A Model to Improve Resident Education and Patient Care
Authors: DeFilippis Andrew Paul , Tellez Ildefonso , Winawer Neil , Di Francesco Lorenzo , Manning Kimberly D. , Kripalani Sunil 
Published: March 2010

Abstract

Background
In 2003, the Accreditation Council for Graduate Medical Education instituted common duty hour limits, and in 2008 the Institute of Medicine recommended additional limits on continuous duty hours. Using a night-float system is an accepted approach for adhering to duty hour mandates.

Objective
To determine the effect of an on-site night-float attending physician on resident education and patient care.

Methods
Night-float residents and daytime ward residents were surveyed at the end of their rotation about the impact of an on-site night-float attending physician on education and quality of patient care. Responses were provided on a 5-point Likert scale ranging from 1, strongly agree, to 5, strongly disagree.

Results
Overall, 92 of the 140 distributed surveys were completed (66% response rate). Night-float residents found the night-float attending physician to be helpful with cross-cover issues (mean  =  2.00), initial history and physical examination (mean  =  1.56), choosing appropriate diagnostic tests (mean  =  1.79), developing a treatment plan (mean  =  1.74), and improving overall patient care (mean  =  1.91). Daytime ward residents were very satisfied with the quality of the admission workups (mean  =  1.78), tests and diagnostic procedures (mean  =  1.76), and initial treatment plan (mean  =  1.62) provided by the night-float service.

Conclusion
A night-float system that includes on-site attending physician supervision can provide a valuable opportunity for resident education and may help improve the quality of patient care.
Ecological Studies on the Planktonic Protozoa of a Small Artificial Pond1
Authors: BAMFORTH STUART S. 
Published: March 2010

A one‐year survey was conducted on a small artificial pond to determine environmental relationships of planktonic protozoa to physical and inorganic chemical factors.Collections were made at 9:00 A. M., Eastern Standard Time, every other day. Planktonic samples were taken from the surface and bottom, and sunlight intensity and temperature were measured. Chemical analyses included alkalinity, carbon dioxide, chloride, dissolved oxygen, nitrate, nitrite, ammonia, phosphate, pH, hardness, and turbidity. Bacteria counts were made microscopically, and protozoa were handled by the Sedgwick‐Rafter method.The order of appearance of phytoplankton may have been influenced by the abundance of growth factors coupled with varying amounts of dissolved substances: Cryptomonas appeared in autumn and early summer; chrysomonads and Chlamydomonas in winter; Glenodinium, Pyramimonas, and diatoms in spring; and euglenoids in summer.The amount of phosphate seemed to influence which phytoplankters appeared: chrysomonads were not found when the water contained more than 0.02 ppm of phosphate, whereas cryptomonads and diatoms increased at this concentration, and euglenoids were abundant at several times this concentration. Within each phosphate range other factors, such as nitrogen sources and growth factors, exercised more immediate effects. Supply of organic nutrients appeared to influence euglenoid numbers.Increases in sunlight and temperature were favorable for diatoms but unfavorable for Glenodinium cinctum and Trachelomonas hispida.The nature and amount of food appeared to be the controlling factor for ciliates.Many plankters live perilously close to minimum survival conditions, and slight environmental changes can promote rapid growth, reduction, or subsidence of a population. This survey shows that detailed studies are necessary to ascertain ecological relationships of microorganisms, and that protozoan habitats must be defined more precisely.
The Effect of Grain Size on the Distribution of Small Invertebrates Inhabiting the Beaches of Puget Sound
Authors: WIESER WOLFGANG 
Published: March 2010

The position with respect to the general configuration of the shore‐line and the direction and force of the currents of five localities in Puget Sound is such that they represent a series of decreasing exposure, Richmond Beach being the most exposed, Bainbridge Island the most sheltered locality. This is reflected in the composition of the substrate, the former locality having the coarsest, the latter the finest substrate. Perpendicular to this horizontal gradient there runs a vertical gradient due to the tide, the coarse grades being deposited in the upper, the fine grades in the lower intertidal.The intertidal distribution of at least some of the more common species of invertebrates on the beaches is not so much determined by levels of tidal water as by the pattern of distribution of certain grades of substrate. For example, species of this sort will penetrate into the upper intertidal if the preferred substrate occurs there, but they will remain in the lower intertidal if the substrate is confined to this zone.On the beaches there exist mixtures of sand which constitute barriers separating major faunal components from each other. It is assumed that substrates with a median diameter of approximately 200µ constitute such a barrier separating the bulk of interstitial sliders from a great number of burrowing animals. The former can move only in sand coarse enough to maintain an interstitial system; the latter, for mechanical reasons, will find fine sand more favorable than coarse. This distinction, however, does not apply to nematodes which are able to move even in the interstices of fine sand. There are various ways in which grain size and shape can influence the distribution of the fauna. These types of relationship are discussed.
SEASONAL CHANGES IN THE ATTACHED ALGAE OF FRESHWATER AND SALINE LAKES IN THE LOWER GRAND COULEE, WASHINGTON1
Authors: Castenholz Richard W. 
Published: March 2010

A two year investigation of two freshwater alkaline lakes and two saline lakes in the Lower Grand Coulee has provided a quantitative and qualitative record of many of the seasonal changes occurring in the non‐planktonic algae. A glass plate method satisfactorily recorded quantitative changes in the attached algae. The plates (28 by 28 cm) were submerged for 2 to 4 weeks at various depths. Dry weight and ash‐free dry weight of the predominantly algal attachment materials on plates were determined, and the ash‐free weight was expressed as a production rate. The ash from freshwater lakes was composed normally of intact diatom frustules. The ash from saline lakes was also diatomaceous, but the weakly silicified frustules were deformed during ashing. Proportional counts of the various species in freshwater lakes were made using the ash. The evaluation of relative dominance was based on the mathematical product of the cell count and a calculated volume factor for each species. The glass‐plate production technique was examined at some length and it was concluded that a 2‐week submergence period was most satisfactory, that glass was not unduly selective, that a horizontal position was satisfactory, and that the method was best suited to the freshwater lakes.In freshwater lakes (200–450 ppm T.D.S.) results clearly show a bimodal production curve with the peak generally higher in the spring than in the fall. Lowest production invariably occurred in late summer. High production values in the spring were commonly near or above 500 mg/m2/day. Comparison of the results of two years shows sizable differences in total production at comparable times of year, but the seasonal distribution of species followed the same general pattern both years. Cymbella affinis, C. cistula, C. mexicana, Diatoma elongatum, Fragilaria vaucheriae, Gomphonema eriense, Nitzchia spp., Synedra acus, and S. ulna were characteristic spring dominants in the freshwater lakes. These diatoms were replaced in summer mainly by Epithemia sorex, E. turgida, and Rhopalodia gibba. A few “spring” species were common in one lake in summer but only at greater depths. TheNine per cent of the 275 algal taxa collected in the Lower Grand Coulee occurred in both freshwater and saline lakes. Although the saline lakes were not rich in numbers of species, production rates were similar to and even higher than production rates in the freshwater lakes. In the two saline lakes (Lake Lenore‐10,000 ppm and Soap Lake—25,000 ppm) there was a pronounced diatom pulse in the fall. Production rate values as high as 550 mg/m2/day were achieved during this season. In Soap Lake a winter pulse reached a value of 1000 mg/m2/day which was followed by a distinct spring pulse, both absent in Lake Lenore. The dominants on glass plates in both lakes were species of Nitzschia and Amphora. Blue‐green algae were also common and were conspicuous for their lack of seasonality.
ON INTERNAL WAVES IN LAKES
Authors: Bryson Reid A. , Ragotzkie Robert A. 
Published: March 2010

The dominant feature of short period thermal unrest in a stratified lake is the periodic nature of the temperature variation. When such variations at a point occur within a few minutes, periodic vertical motions of the water are implied, for other heat transfer mechanisms within the lake are too slow. These periodic motions, internal waves, may be studied at a given depth by simultaneous continuous temperature measurement at three closely spaced stations. From these observations and the mean vertical gradient the amplitude, direction, period, and speed of the internal waves have been determined.Long, standing internal waves have been described often in the literature as seen through temperature observations. They may also be studied by means of their “surface reflection.”
THE POTENTIAL TROPHIC SIGNIFICANCE OF CALLIANASSA MAJOR FECAL PELLETS1
Authors: Frankenberg Dirk , Coles Stephen Lee , Johannes R. E. 
Published: March 2010

The trophic significance of the fecal pellets of Callianassa major was investigated by measuring 1) the rates at which fecal material was produced, 2) its organic carbon and nitrogen content, and 3) its ingestion by other animals. Our results indicate that 456 ± 118 fecal pellets are produced per burrow per day and from 175 ± 46 to 2,600 ± 670 pellets m−2 day−1, depending on population density, and that an entire C. major population occupying an area of about 200,000 m2 produces about 280 × 106 pellets/day. The carbon and nitrogen contents of the pellets were 3 and 0.3% of their dry weight. Aging the pellets had no effect on their carbon content but halved the nitrogen content in 48 hr. Ingestion experiments indicated that fecal pellets were eaten by hermit crabs, probably by blue crabs, and possibly by several other beach inhabitants.The results were used to calculate the rate at which organic carbon is made available in fecal pellets, and this rate was compared to production rate measurements for local primary producers. The potential quantitative significance of fecal pellets as a food source is discussed.
VERTICAL MIGRATION AND AVOIDANCE CAPABILITY OF EUPHAUSIIDS IN THE CALIFORNIA CURRENT
Authors: Brinton Edward 
Published: March 2010

Comparisons of day and night vertical distributions of euphausiids at the same stations make it possible to estimate 1) the extent of vertical migration of the furcilia, juveniles, and adults of the Euphausiacea (Crustacea) species, or 2) their ability to avoid the net in the daytime, or both. Seven species of Euphausia and one of Thysanopoda migrated more than 300 m, rising to near the surface at night. Adults of Nematoscelis (three species) migrated vertically but were bounded at upper limits by the thermocline at all but the most inshore stations. Nyctiphanes simplex and Stylocheiron carinatum were short‐distance (ca. 150–0 m) migrants. The extent of vertical migration was greatest in the most offshore central water, intermediate for midcurrent species, and least for coastal.Nonmigrants included all Stylocheiron species (except S. carinatum), Thysanoessa gregaria, and two Nematobrachion species. S. affine, S. suhmi, and T. gregaria inhabited the homogeneous layer. Apparent increases with depth in their daytime densities arise from avoidance of nets in the upper layers. This is minimal at ca. 100 m, where day and night densities are nearly equal.
EFFECTS OF ENVIRONMENTAL CONDITIONS ON THE RATE OF PHOTOSYNTHESIS AND SOME PHOTOSYNTHETIC ENZYMES IN DUNALIELLA TERTIOLECTA BUTCHER1
Authors: Hellebust Johan A. , Terborgh John 
Published: March 2010

Exponentially growing Dunaliella tertiolecta raised under continuous light increased both in photosynthetic capacity and in the activities of two enzymes of the photosynthetic reductive pentose cycle during the first 24 hr after transfer to complete darkness at 18C. A rapid decrease in photosynthetic capacity and enzyme activities followed. Three days after transfer to darkness, the photosynthetic capacity was only 25% of the initial value, while the corresponding figures for RuDP carboxylase and aldolase activities were 25 and 20%.Decline of these metabolic parameters at 18C was greatly delayed by continuous illumination of 20 µw/cm2, an intensity considerably below the compensation point. After seven days, the photosynthetic capacity was still 78%, and the RuDP carboxylase and aldolase activities were 65 and 40% of their initial values. The same light intensity at a lower temperature (5C) almost entirely eliminated the decrease in photosynthesis and enzyme activities over a 21‐day period.Changes in RuDP carboxylase activity followed closely those in the rate of photosynthetic dark reactions. Parallel changes in the rate of light reactions suggest that the changes in the dark and light systems are interdependent.Light quality studies indicate that light absorbed by photosynthetic pigments is primarily responsible for decreasing the rate of loss of photosynthetic capacity and RuDP carboxylase activity. It is suggested that light of low intensity, as well as low temperature, may be ecologically important in maintaining the photosynthetic capacity of plankton algae when they are removed from the euphotic zone for a considerable length of time through sinking or vertical mixing.
UNUSUAL MONOMIXIS IN TWO SALINE ARIZONA PONDS1
Authors: Cole Gerald A. , Whiteside Melbourne C. , Brown Robert J. 
Published: March 2010

Red Pond and Green Pond are shallow, saline pools in Apache County, Arizona, that stratify chemically during winter and circulate in midsummer. Stability is brought about by addition of dilute runoff and seep water to the surfaces; circulation occurs because evaporation increases the salinity of the upper waters and lowers the pond surfaces. Isothermy, dichothermy, mesothermy, and poikilotherny occur during the year. Winter stabilities are in excess of 200 g‐cm/cm2 in spite of anomalous temperature profiles and the shallow nature of the ponds.The waters are chloro‐carbonates derived by concentration from dilute waters relatively high in sulfate and carbonate. At the overturn, Red Pond and Green Pond have salinities of 22% and 11%. Phosphate concentrations are remarkably high—up to 500 mg/liter in Red Pond.Ctenocladus circinnatus is present in both ponds; this may be the fourth North American record for this green alga.
SEDIMENTATION IN THE ESTUARY OF THE RIVER CROUCH, ESSEX, ENGLAND
Authors: Sheldon R. W. 
Published: March 2010

The coast of Essex is bordered by marshland and is subsiding. Under natural conditions sedimentation on the marshes keeps pace with subsidence, but where the land has been reclaimed and embanked, subsidence has continued with no compensating sedimentation.Material in suspension is flocculated and is mainly inorganic but may contain up to 25% organic material. Particle diameters of the flocculi range from less than 1 µ to about 80 µ with a mean at about 10–15 µ. The concentration varies with state of tide, depth, and location. There is more material near the bottom than at the surface, and greater concentrations occur near the mouth than near the head of the estuary.Bottom deposits are made up of two distinct particle populations. There is a fine sand fraction which is believed to be transported near the bottom, and a silt fraction derived from suspension. Offshore, in areas exposed to wave action, there arc fine sands with very little silt. The proportion of silt increases and the modal diameter of the fine sand fraction decreases towards the head of the estuary.The sediments may be derived from offshore deposits of boulder clay, and evidence was found to suggest that these deposits are being eroded by tidal currents. Material eroded from an unsorted boulder clay could produce the distribution of sedimentary properties found in the Essex estuaries.
THE RELATIVE CONTRIBUTION OF PARTICULATE CHLOROPHYLL AND RIVER TRIPTON TO THE EXTINCTION OF LIGHT OFF THE COAST OF OREGON1
Authors: Small Lawrence F. , Curl Herbert 
Published: March 2010

Extinction coefficients and chlorophyll a concentrations were measured for three years along sampling lines off the mouth of a large river (Columbia), a relatively small river (Yaquina), and a section of Oregon coastline with little river outflow. The relative contribution of particulate chlorophyll and nonliving suspended matter (tripton) to the extinction coefficient, k, was assessed using a three‐component equation that allowed the separation of areas and seasons in which k was a function of chlorophyll concentration from areas and seasons in which other factors besides chlorophyll concentration were involved.The effect of river discharge into the sea is twofold: to increase tripton turbidity, and thus k, and to change the oceanic relationship between chlorophyll a concentration and k in areas subject to, but not overwhelmed by, river discharge. The first effect is more pronounced with large volumes of discharge and becomes less significant with increasing distances from the river mouth. Beyond the areas of masking of this relationship by tripton turbidity, k apparently is a function of chlorophyll concentration only in winter and spring (through mid‐May) when river discharge is low. In areas that never receive significant river discharge, k is a function of chlorophyll concentration during all seasons except possibly summer, when upwelling may at times destroy the relationship.