CLEIMS: Outcomes of a randomised educational trial of extended immersion in medical simulation

To report the outcomes of a randomised educational trial of a new methodology for extended immersion in medical simulation for senior medical students. Clinical Learning through Extended Immersion in Medical Simulation (CLEIMS) is a new methodology for medical student learning. It involves senior students working in teams of 4-5 through the clinical progress of one or more patients over a week, utilising a range of simulation methodologies (simulated patient assessment, simulated significant other briefing, virtual story continuations, pig-trotter wound repair, online simulated on-call modules, interprofessional simulated ward rounds and high fidelity mannequin-based emergency simulations), to enhance learning in associated workshops and seminars. A randomised educational trial comparing the methodology to seminars and workshops alone began in 2010 and interim results were reported at last year’s conference. Updated results are presented here and final primary endpoint outcomes will be available by the time of the conference.

Impaction of spray droplets on leaves: Influence of formulation and leaf character on shatter, bounce and adhesion

This paper combines experimental data with simple mathematical models to investigate the influence of spray formulation type and leaf character (wettability) on shatter, bounce and adhesion of droplets impacting with cotton, rice and wheat leaves. Impaction criteria that allow for different angles of the leaf surface and the droplet impact trajectory are presented; their predictions are based on whether combinations of droplet size and velocity lie above or below bounce and shatter boundaries. In the experimental component, real leaves are used, with all their inherent natural variability. Further, commercial agricultural spray nozzles are employed, resulting in a range of droplet characteristics. Given this natural variability, there is broad agreement between the data and predictions. As predicted, the shatter of droplets was found to increase as droplet size and velocity increased, and the surface became harder to wet. Bouncing of droplets occurred most frequently on hard to wet surfaces with high surface tension mixtures. On the other hand, a number of small droplets with low impact velocity were observed to bounce when predicted to lie well within the adhering regime. We believe this discrepancy between the predictions and experimental data could be due to air layer effects that were not taken into account in the current bounce equations. Other discrepancies between experiment and theory are thought to be due to the current assumption of a dry impact surface, whereas, in practice, the leaf surfaces became increasingly covered with fluid throughout the spray test runs.

Anodized nanoporous WO3 Schottky contact structure for hydrogen and ethanol sensing

This paper reports the development of nanoporous tungsten trioxide (WO3) Schottky diode-based gas sensors. Nanoporous WO3 films were prepared by anodic oxidation of tungsten foil in ethylene glycol mixed with ammonium fluoride and a small amount of water. Anodization resulted in highly ordered WO3 films with a large surface-to-volume ratio. Utilizing these nanoporous structures, Schottky diode-based gas sensors were developed by depositing a platinum (Pt) catalytic contact and tested towards hydrogen gas and ethanol vapour. Analysis of the current–voltage characteristics and dynamic responses of the sensors indicated that these devices exhibited a larger voltage shift in the presence of hydrogen gas compared to ethanol vapour at an optimum operating temperature of 200 °C. The gas sensing mechanism was discussed, associating the response to the intercalating H+ species that are generated as a result of hydrogen and ethanol molecule breakdowns onto the Pt/WO3 contact and their spill over into nanoporous WO3.

Randomized clinical trial of the timing it right stroke family support program: Research protocol

Background Family caregivers provide invaluable support to stroke survivors during their recovery, rehabilitation, and community re-integration. Unfortunately, it is not standard clinical practice to prepare and support caregivers in this role and, as a result, many experience stress and poor health that can compromise stroke survivor recovery and threaten the sustainability of keeping the stroke survivor at home. We developed the Timing it Right Stroke Family Support Program (TIRSFSP) to guide the timing of delivering specific types of education and support to meet caregivers' evolving needs. The objective of this multi-site randomized controlled trial is to determine if delivering the TIRSFSP across the stroke care continuum improves caregivers' sense of being supported and emotional well-being. Methods/design Our multi-site single-blinded randomized controlled trial will recruit 300 family caregivers of stroke survivors from urban and rural acute care hospitals. After completing a baseline assessment, participants will be randomly allocated to one of three groups: 1) TIRSFSP guided by a stroke support person (health care professional with stroke care experience), delivered in-person during acute care and by telephone for approximately the first six to 12 months post-stroke; 2) caregiver self-directed TIRSFSP with an initial introduction to the program by a stroke support person, or; 3) standard care receiving the educational resource "Let's Talk about Stroke" prepared by the Heart and Stroke Foundation. Participants will complete three follow-up quantitative assessments 3, 6, and 12-months post-stroke. These include assessments of depression, social support, psychological well-being, stroke knowledge, mastery (sense of control over life), caregiving assistance provided, caregiving impact on everyday life, and indicators of stroke severity and disability. Qualitative methods will also be used to obtain information about caregivers' experiences with the education and support received and the impact on caregivers' perception of being supported and emotional well-being. Discussion This research will determine if the TIRSFSP benefits family caregivers by improving their perception of being supported and emotional well-being. If proven effective, it could be recommended as a model of stroke family education and support that meets the Canadian Stroke Best Practice Guideline recommendation for providing timely education and support to families through transitions.

Students’ well-being and social connections

Description of Workshop/Poster Presentation This presentation will showcase CORE Connections – ‘Creating Opportunities for Resilience and Engagement’ – which is a whole-school approach to mental health promotion. While initially designed to prevent adolescent depression and substance abuse, current thinking suggests that competency enhancement (e.g., autonomy, competence, supportive networks) more widely improves students’ well-being, educational engagement, and learning outcomes. In the presentation, we will provide an overview of the CORE project, describe the CORE intervention, which is conceptualized as a dynamic and penetrating process of social practices, present some preliminary findings from the pilot phase of CORE, and conclude our presentation with an interactive section with the participants. This project will highlight a wellness focus that addresses social engagement within whole school cultures. Purpose of the Presentation Student mental and physical well-being has gained increasing attention. Our presentation will introduce the CORE project, which has a potential to decrease student depression, anxiety, and substance use, and to increase student self-esteem and learning outcomes. In this vein, our presentation will raise the public awareness of the salient role of social connection in student well-being. Specifically, a group of presenters will discuss the impact of social connection on students’ anxiety, mathematics achievement, and perceived racial discrimination. • We will present participants with an alternative way to conceptualize and approach mental health promotion within a school context. In contrast to prescribed programs that are commonly used in today’s schools, CORE is a whole-school approach that is flexibly integrated into all aspects of the classroom and school environment. Our aim is to illustrate the intervention principles of CORE while highlighting examples of mental health outcomes/transformation. • Underutilized in mental health promotion research, social network analysis provides critical information in understanding relationships between social cohesion (e.g., a student’s connectedness to others) and mental health outcomes. This session will showcase how focusing on and strengthening social connections in and out of school can contribute to student well-being, achievement, and mental health. Educational Objectives By the end of the presentation, participants will • obtain a general overview of the CORE program, • understand how psychological health and school performance relate to student well-being, • and understand how social connections in and out of school can contribute to student well-being. Interactive / Participatory Component We will invite audience members to discuss inhibitors and contributors to student well-being and the best ways for schools to help students feel safe, connected, and valued. Presentation Key Points • Overview of the CORE project • Theorization of social connection • Some empirical studies emerging from CORE • Presenter-audience interaction Evidence of Relevance and Utility to Participants Potential participants are adults with significant relationships with students, either as family members, community neighbors, educators, scholars, service providers, or policy makers. Our presentation will inspire these significant adults to construct a welcoming society to help improve student well-being.

A feasibility and pilot randomized controlled trial of the "Timing it Right Stroke Family Support Program"

- Objective Examine feasibility of conducting a randomized controlled trial of the Timing it Right Stroke Family Support Program (TIRSFSP) and collect pilot data. - Design Multi-site mixed method randomized controlled trial. - Setting Acute and community care in three Canadian cities. - Subjects Caregivers were family members or friends providing care to individuals who experienced their first stroke. - Intervention The TIRSFSP offered in two formats, self-directed by the caregiver or stroke support person-directed over time, were compared to standard care. - Main Measures Caregivers completed baseline and follow-up measures 1, 3 and 6 months post-stroke including Centre for Epidemiological Studies Depression, Positive Affect, Social Support, and Mastery Scales. We completed in-depth qualitative interviews with caregivers and maintained intervention records describing support provided to each caregiver. - Results Thirty-one caregivers received standard care (n=10), self-directed (n=10), or stroke support person-directed (n=11) interventions. We retained 77% of the sample through 6-months. Key areas of support derived from intervention records (n=11) related to caregiver wellbeing, caregiving strategies, patient wellbeing, community re-integration, and service delivery. Compared to standard care, caregivers receiving the stroke support person-directed intervention reported improvements in perceived support (estimate 3.1, P=.04) and mastery (estimate .35, P=.06). Qualitative caregiver interviews (n=19) reflected the complex interaction between caregiver needs, preferences and available options when reporting on level of satisfaction. - Conclusions Preliminary findings suggest the research design is feasible, caregivers’ needs are complex, and the support intervention may enhance caregivers’ perceived support and mastery. The intervention will be tested further in a large scale trial.

Impact of a stroke unit on length of hospital stay and in-hospital case fatality

Background and Purpose Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward. Methods A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index. Results Average length of stay for patients on a stroke unit (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay >7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; P<0.0001). The adjusted odds of a length of stay >7 days was reduced by 30% (P<0.0001) on a stroke unit compared to general neurology/medical wards. Overall in-hospital case fatality was reduced by 4.5% with stroke unit care. Conclusions We observed a reduced length of stay and reduced in-hospital case-fatality in a stroke unit compared to general neurology/medical wards.

Determining the drivers of m-banking adoption: A cross cultural study

This study empirically examines the motivators that influence a consumer’s intentions to use mobile banking. A web-based survey was employed to collect data from 348 respondents, split across Thailand and Australia. Data were analysed by employing exploratory and confirmatory factor analyses, path and invariance analyses. The findings indicate that for Australian consumers, perceived ease of use, perceived usefulness and perceived risk were the primary determinants of mobile banking adoption. For Thai consumers, the main factors were perceived usefulness, perceived risk and social influence. National culture was found to impact key antecedents that lead to adoption of m-banking. Interestingly, the actual variance explained by this study’s model was higher in Australia than for Thailand, suggesting future research of m-banking adoption in emerging Asian cultures. The findings of this research give banking organisations a foundational model that can be used to support m-banking implementation. This study is perhaps the first to examine and compare the intention to adopt m-banking across Thai and Australian consumers, and responds to calls for additional research that generalises m-banking and m-services acceptance across cultures. This study has proposed and validated additional constructs that are not present in the original SST Intention to Use model.

Drivers of local food consumption: A comparative study

Purpose The aim of this paper is to empirically explore antecedents of local food purchase intention in two food producing countries with different cultural backgrounds. Design/methodology/approach An online survey was employed to collect data from consumers located in Chile (n=283) and Australia (n=300). A proposed model is tested with structural equation modelling (SEM). Findings Attitude towards consuming local food is a strong and direct driver of intentions to purchase local food in both countries. Attitude toward supporting local agri-businesses and consumer ethnocentrism are found to positively impact attitude towards consuming local food in both countries. Attitude towards local agri-businesses also has a direct effect on intentions to purchase local food in Australia, but not in Chile. Interestingly, subjective norms are not found to affect intentions to consume local food in either country. Research limitations/implications The paper examines factors affecting the attitude toward and behavioural intention regarding local food consumption and develops an extended model of local food consumption. An outcome of this new model is the inclusion of personal variables, which influence local food purchasing behaviour. Practical implications Producers and retailers need to develop campaigns explaining how consuming local food supports local businesses and farmers, which will reinforce personal values associated with local consumption. Originality/value This is the first study to demonstrate that positive attitudes toward local foods are important drivers of local food purchase behaviour, independent of the cultural characteristics or level of economic development within a country.

Distribution Revolution: Conversations about the Digital Future of Film and Television

Distribution Revolution is a collection of interviews with leading film and TV professionals concerning the many ways that digital delivery systems are transforming the entertainment business. These interviews provide lively insider accounts from studio executives, distribution professionals, and creative talent of the tumultuous transformation of film and TV in the digital era. The first section features interviews with top executives at major Hollywood studios, providing a window into the big-picture concerns of media conglomerates with respect to changing business models, revenue streams, and audience behaviors. The second focuses on innovative enterprises that are providing path-breaking models for new modes of content creation, curation, and distribution—creatively meshing the strategies and practices of Hollywood and Silicon Valley. And the final section offers insights from creative talent whose professional practices, compensation, and everyday working conditions have been transformed over the past ten years. Taken together, these interviews demonstrate that virtually every aspect of the film and television businesses is being affected by the digital distribution revolution, a revolution that has likely just begun. Interviewees include: • Gary Newman, Chairman, 20th Century Fox Television • Kelly Summers, Former Vice President, Global Business Development and New Media Strategy, Walt Disney Studios • Thomas Gewecke, Chief Digital Officer and Executive Vice President, Strategy and Business Development, Warner Bros. Entertainment • Ted Sarandos, Chief Content Officer, Netflix • Felicia D. Henderson, Writer-Producer, Soul Food, Gossip Girl • Dick Wolf, Executive Producer and Creator, Law & Order

Verification and Operation of Adaptive Materials in Space

Piezoelectric polymers based on polyvinylidene fluoride (PVDF) are of interest as smart materials for novel space-based telescope applications. Dimensional adjustments of adaptive thin polymer films are achieved via controlled charge deposition. Predicting their long-term performance requires a detailed understanding of the piezoelectric property changes that develop during space environmental exposure. The overall materials performance is governed by a combination of chemical and physical degradation processes occurring in low Earth orbit as established by our past laboratory-based materials performance experiments (see report SAND 2005-6846). Molecular changes are primarily induced via radiative damage, and physical damage from temperature and atomic oxygen exposure is evident as depoling, loss of orientation and surface erosion. The current project extension has allowed us to design and fabricate small experimental units to be exposed to low Earth orbit environments as part of the Materials International Space Station Experiments program. The space exposure of these piezoelectric polymers will verify the observed trends and their degradation pathways, and provide feedback on using piezoelectric polymer films in space. This will be the first time that PVDF-based adaptive polymer films will be operated and exposed to combined atomic oxygen, solar UV and temperature variations in an actual space environment. The experiments are designed to be fully autonomous, involving cyclic application of excitation voltages, sensitive film position sensors and remote data logging. This mission will provide critically needed feedback on the long-term performance and degradation of such materials, and ultimately the feasibility of large adaptive and low weight optical systems utilizing these polymers in space.

The thrill of victory: Women and sport shopping

This study explores a new shopper type, ‘Sport Shoppers’, who are unique in their actions, attitudes and behaviors. We present evidence that these shoppers exhibit behavior similar to that of competitive athletes in that they view bargain shopping as an achievement domain. Data were collected through open-ended surveys, in-depth interviews and closet inventories. Thematic analysis of transcripts was undertaken based on three achievement goal categories; task-oriented, ego-oriented and social approval-oriented. Achievement goal theory is employed to offer an explanation of the Sport Shoppers’ behaviors and motivations. We argue the Sport Shopper is an economically viable and important shopper for fashion retailers to target.