How can experience in clinical and community settings contribute to early medical education? A BEME systematic review

Review date: Review period January 1992-December 2001. Final analysis July 2004-January 2005. Background and review context: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education. Objectives of review: (1) Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it. (2) Identify the strengths and limitations of the research effort to date, and identify objectives for future research. Search strategy: Ovid search of. BEI, ERIC, Medline, CIATAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of: Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology. Criteria: Definitions: Experience: Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional. Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years. Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included. Exclusions: Not empirical; not early; post-basic; simulated rather than 'authentic' experience. Data collection: Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation. Headline results: A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those outcomes were from descriptive studies and 24% from comparative studies. Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity. It strengthened their learning and made it more real and relevant to clinical practice. It helped students learn about the structure and function of the healthcare system, and about preventive care and the role of health professionals. It supported the learning of both biomedical and behavioural/social sciences and helped students acquire communication and basic clinical skills. There were outcomes for beneficiaries other than students, including teachers, patients, populations, organizations and specialties. Early experience increased recruitment to primary care/rural medical practice, though mainly in US studies which introduced it for that specific purpose as part of a complex intervention. Conclusions: Early experience helps medical students socialize to their chosen profession. It. helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can influence career choices.

Levels of 12 perfluorinated chemicals in pooled Australian serum, collected 2002-2003, in relation to age, gender, and region

Pooled serum samples from 3802 Australian residents were analyzed for four perfluoroalkylsulfonates, seven perfluoroalkylcarboxylates, and perfluorooctanesulfonamide (PFOSA). Serum was collected from men and women of five different age groups and from rural and urban regions in Australia. The highest mean concentration was obtained for perfluorooctane sulfonate (PFOS, 20.8 ng/mL) followed by perfluorooctanoic acid (PFOA, 7.6 ng/mL), perfluorohexane sulfonate (PFHxS, 6.2 ng/mL), perfluorononanoic acid (PFNA, 1.1 ng/mL), and PFOSA (0.71 ng/mL). Additional four PFCs were detected in 5-18 % of the samples at concentrations near the detection limits (0.1-0.5 ng/mL). An increase in PFOS concentration with increasing age in both regions and genders was observed. The male pool levels of some of the age groups compared to females were higher for PFOS, PFOA, and PFHxS. In contrast, PFNA concentrations were higher in the female pools. No substantial difference was found in levels of PFCs between the urban and rural regions. The levels are equal or higher than previously reported serum levels in Europe and Asia but lower compared to the U. S. A. These results suggest that emissions from production in the Northern Hemisphere are of less importance for human exposure.

Long wave generation by the shoaling and breaking of transient wave groups on a beach

This paper presents new laboratory data on the generation of long waves by the shoaling and breaking of transient-focused short-wave groups. Direct offshore radiation of long waves from the breakpoint is shown experimentally for the first time. High spatial resolution enables identification of the relationship between the spatial gradients of the short-wave envelope and the long-wave surface. This relationship is consistent with radiation stress theory even well inside the surf zone and appears as a result of the strong nonlinear forcing associated with the transient group. In shallow water, the change in depth across the group leads to asymmetry in the forcing which generates significant dynamic setup in front of the group during shoaling. Strong amplification of the incident dynamic setup occurs after short-wave breaking. The data show the radiation of a transient long wave dominated by a pulse of positive elevation, preceded and followed by weaker trailing waves with negative elevation. The instantaneous cross-shore structure of the long wave shows the mechanics of the reflection process and the formation of a transient node in the inner surf zone. The wave run-up and relative amplitude of the radiated and incident long waves suggests significant modification of the incident bound wave in the inner surf zone and, the dominance of long waves generated by the breaking process. It is proposed that these conditions occur when the primary short waves and bound wave are not shallow water waves at the breakpoint. A simple criterion is given to determine these conditions, which generally occur for the important case of storm waves.

On the equilibrium and dynamic behavior of alcohol vapors in activated carbon

As alcohol molecules such as methanol and ethanol have both polar and non-polar groups, their adsorption behavior is governed by the contributions of dispersion interaction (alkyl group) and hydrogen bonding (OH group). In this paper, the adsorption behavior of alcohol molecules and its effect on transport processes are elucidated. From the total permeability (B-T) of alcohol molecules in activated carbon, an adsorption mechanism is proposed, describing well the experimental data, by taking combination effects of clustering, entering micropores, layering and pore filling processes. Unlike the case of non-polar compounds, it was found that at low pressures there are two rises in the BT of alcohol molecules in activated carbon. The first rise is due to the major contribution of surface diffusion to the transport (which is the case of non-polar molecules) and the second one may be associated with cluster formation at the edge of micropores and entering micropores when the clusters are sufficiently large enough to induce a dispersive energy. In addition the clusters formed may enhance surface diffusion at low pressures and hinder gas phase diffusion and flow in meso/macropores. (c) 2006 Elsevier Ltd. All fights reserved.

Operation of polymer electrolyte membrane fuel cells with dry feeds: Design and operating strategies

The operation of polymer electrolyte membrane fuel cells (PEMFCs) with dry feeds has been examined with different fuel cell flow channel designs as functions of pressure, temperature and flow rate. Auto-humidified (or self-humidifying) PEMFC operation is improved at higher pressures and low gas velocities where axial dispersion enhances back-mixing of the product water with the dry feed. We demonstrate auto-humidified operation of the channel-less, self-draining fuel cell, based on a stirred tank reactor; data is presented showing auto-humidified operation from 25 to 115 degrees C at 1 and 3 atm. Design and operating requirements are derived for the auto-humidified operation of the channel-less, self-draining fuel cell. The auto-humidified self-draining fuel cell outperforms a fully humidified serpentine flow channel fuel cell at high current densities. The new design offers substantial benefits for simplicity of operation and control including: the ability to self-drain reducing flooding, the ability to uniformly disperse water removing current gradients and the ability to operate on dry feeds eliminating the need for humidifiers. Additionally, the design lends itself well to a modular design concept. (c) 2005 Elsevier B.V. All rights reserved.

Scattering and tangential momentum accommodation at a 2D adsorbate-solid interface

We calculate tangential momentum coefficients for the exchange of momentum between molecules in transport and the internal surface of a membrane pore, modelled as a simple atomic structure. We introduce a local specular reflection (LSR) hypothesis, which states that impinging molecules undergo mirror-like reflection in a plane tangent to a surface atom at the point of impact. As a consequence, the components of the velocity, parallel to the direction of flow will (in general) change on impact. The overall effect is a loss of tangential momentum, since more is lost in the upstream direction than is gained in the downstream direction. The loss of tangential momentum is greater when the size ratio of fluid to solid atom is small, allowing more steeply inclined impact planes to become accessible to the fluid phase molecules. (c) 2005 Elsevier B.V. All rights reserved.

Simulation of binary mixture adsorption of methane and CO2 at supercritical conditions in carbons

Knowledge of the adsorption behavior of coal-bed gases, mainly under supercritical high-pressure conditions, is important for optimum design of production processes to recover coal-bed methane and to sequester CO2 in coal-beds. Here, we compare the two most rigorous adsorption methods based on the statistical mechanics approach, which are Density Functional Theory (DFT) and Grand Canonical Monte Carlo (GCMC) simulation, for single and binary mixtures of methane and carbon dioxide in slit-shaped pores ranging from around 0.75 to 7.5 nm in width, for pressure up to 300 bar, and temperature range of 308-348 K, as a preliminary study for the CO2 sequestration problem. For single component adsorption, the isotherms generated by DFT, especially for CO2, do not match well with GCMC calculation, and simulation is subsequently pursued here to investigate the binary mixture adsorption. For binary adsorption, upon increase of pressure, the selectivity of carbon dioxide relative to methane in a binary mixture initially increases to a maximum value, and subsequently drops before attaining a constant value at pressures higher than 300 bar. While the selectivity increases with temperature in the initial pressure-sensitive region, the constant high-pressure value is also temperature independent. Optimum selectivity at any temperature is attained at a pressure of 90-100 bar at low bulk mole fraction of CO2, decreasing to approximately 35 bar at high bulk mole fractions. (c) 2005 American Institute of Chemical Engineers.

Simulation study of methanol and ethanol adsorption on graphitized carbon black

GCMC simulations are applied to the adsorption of sub-critical methanol and ethanol on graphitized carbon black at 300 K. The carbon black was modelled both with and without carbonyl functional groups. Large differences are seen between the amounts adsorbed for different carbonyl configurations at low pressure prior to monolayer coverage. Once a monolayer has been formed on the carbon black, the adsorption behaviour is similar between the model surfaces with and without functional groups. Simulation isotherms for the case of low carbonyl concentrations or no carbonyls are qualitatively similar to the few experimental isotherms available in the literature for methanol and ethanol adsorption on highly graphitized carbon black. Isosteric heats and adsorbed phase heat capacities are shown to be very sensitive to carbonyl configurations. A maximum is observed in the adsorbed phase heat capacity of the alcohols for all simulations but is unrealistically high for the case of a plain graphite surface. The addition of carbonyls to the surface greatly reduces this maximum and approaches experimental data with carbonyl concentration as low as 0.09 carbonyls/nm(2).

Structural evolution in a hydrothermal reaction between Nb2O5 and NaOH solution: From Nb2O5 grains to microporous Na2Nb2O6 center dot(2)/3H2O fibers and NaNbO3 cubes

Niobium pentoxide reacts actively with concentrate NaOH solution under hydrothermal conditions at as low as 120 degrees C. The reaction ruptures the corner-sharing of NbO7 decahedra and NbO6 octahedra in the reactant Nb2O5, yielding various niobates, and the structure and composition of the niobates depend on the reaction temperature and time. The morphological evolution of the solid products in the reaction at 180 degrees C is monitored via SEM: the fine Nb2O5 powder aggregates first to irregular bars, and then niobate fibers with an aspect ratio of hundreds form. The fibers are microporous molecular sieve with a monoclinic lattice, Na2Nb2O6 center dot(2)/3H2O. The fibers are a metastable intermediate of this reaction, and they completely convert to the final product NaNbO3 Cubes in the prolonged reaction of 1 h. This study demonstrates that by carefully optimizing the reaction condition, we can selectively fabricate niobate structures of high purity, including the delicate microporous fibers, through a direct reaction between concentrated NaOH solution and Nb2O5. This synthesis route is simple and suitable for the large-scale production of the fibers. The reaction first yields poorly crystallized niobates consisting of edge-sharing NbO6 octahedra, and then the microporous fibers crystallize and grow by assembling NbO6 octahedra or clusters of NbO6 octahedra and NaO6 units. Thus, the selection of the fibril or cubic product is achieved by control of reaction kinetics. Finally, niobates with different structures exhibit remarkable differences in light absorption and photoluminescence properties. Therefore, this study is of importance for developing new functional materials by the wet-chemistry process.

Transport of simple fluids in nanopores: Theory and simulation

A theory is discussed of single-component transport in nanopores, recently developed by Bhatia and coworkers. The theory considers the oscillatory motion of molecules between diffuse wall collisions, arising from the fluid-wall interaction, along with superimposed viscous flow due to fluid-fluid interaction. The theory is tested against molecular dynamics simulations for hydrogen, methane, and carbon tetrafluoride flow in cylindrical nanopores in silica. Although exact at low densities, the theory performs well even at high densities, with the density dependency of the transport coefficient arising from viscous effects. Such viscous effects are reduced at high densities because of the large increase in viscosity, which explains the maximum in the transport coefficient with increase in density. Further, it is seen that in narrow pore sizes of less than two molecular diameters, where a complete monolayer cannot form on the surface, the mutual interference of molecules on opposite sides of the cross section can reduce the transport coefficient, and lead to a maximum in the transport coefficient with increasing density. The theory is also tested for the case of partially diffuse reflection and shows the viscous contribution to be negligible when the reflection is nearly specular. (c) 2005 American Institute of Chemical Engineers AIChE J, 52: 29-38, 2006.

High-pressure adsorption of methane and carbon dioxide on coal

Adsorption isotherms of methane and carbon dioxide on two kinds of Australian coals have been measured at three temperatures up to pressures of 20 MPa. The adsorption behavior is described by three isotherm equations: extended three-parameter, Langmuir, and Toth. Among these, the Toth equation is found to be the most suitable, yielding the most realistic values of pore volume of the coals and the adsorbed phase density. Also, the surface area of coals obtained from CO2 adsorption at 273 K is found to be the meaningful parameter which captures the CO2 adsorption capacity. A maximum in the excess amount adsorbed of each gas appears at a lower pressure with a decrease in temperature. For carbon dioxide, after the appearance of the maximum, an inflection point in the excess amount adsorbed is observed close to the critical density at each temperature, indicating that the decrease in the gas-phase density change with pressure influences the behavior of the excess amount adsorbed. In the context of CO2 sequestration, it is found that CO2 injection pressures of lower than 10 MPa may be desirable for the CH4 recovery process and CO2-holding capacity.

Performance of a scramjet combustor with combined normal and tangential fuel injection

The performance of a scramjet combustor with combined normal and tangential injection was experimentally investigated. Experiments were performed on a 500-mm cylindrical scramjet combustor at a freestream Mach number of 4.5, a nozzle supply pressure of 35.8 MPa, and a nozzle supply enthalpy of 5.8 MJ/kg. Hydrogen fuel was injected normally through portholes to promote combustion and tangentially through a slot to reduce viscous drag. A series of fuel injectors were used to vary the proportion of tangential to normal fuel between 45 and 100%. Reductions in the viscous drag of up to 25% were observed with the greatest reductions occurring at the lowest total equivalence ratio tested for each injector. However, the average pressure produced by combustion with combined normal and tangential injection was approximately 50% less than that produced by normal injection alone. An analysis of the change in specific impulse of the scramjet combustor indicated that the best overall performance was produced by 100% normal injection.

Simulation of glassy state relaxations in polymers: A static analysis of methyl group and methoxy group rotation in poly(vinyl methyl ether)

We show that the simple quasi-static technique, also called the adiabatic mapping technique, can be used to determine the energetics of rotation of methyl and methoxy groups in amorphous poly(vinyl methyl ether) even though the latter process is too slow to be amenable to direct molecular dynamics simulation. For the methyl group rotation, we find that the mean and standard deviation of the simulated rotational barrier heights agree well with experimental data from quasi-elastic neutron scattering. In the case of the methoxy groups we find that just 4% of the groups contribute more than 90% of the observed dielectric relaxation strength. The groups which make the most contribution are those which, by virtue of their particular conformation and local environment, have two alternative positions of similar energy.

Evaluation of the indirect measures of rock brittleness and fracture toughness in rock cutting

Performance prediction models for partial face mechanical excavators, when developed in laboratory conditions, depend on relating the results of a set of rock property tests and indices to specific cutting energy (SE) for various rock types. There exist some studies in the literature aiming to correlate the geotechnical properties of intact rocks with the SE, especially for massive and widely jointed rock environments. However, those including direct and/or indirect measures of rock fracture parameters such as rock brittleness and fracture toughness, along with the other rock parameters expressing different aspects of rock behavior under drag tools (picks), are rather limited. With this study, it was aimed to investigate the relationships between the indirect measures of rock brittleness and fracture toughness and the SE depending on the results of a new and two previous linear rock cutting programmes. Relationships between the SE, rock strength parameters, and the rock index tests have also been investigated in this study. Sandstone samples taken from the different fields around Ankara, Turkey were used in the new testing programme. Detailed mineralogical analyses, petrographic studies, and rock mechanics and rock cutting tests were performed on these selected sandstone specimens. The assessment of rock cuttability was based on the SE. Three different brittleness indices (B1, B2, and B4) were calculated for sandstones samples, whereas a toughness index (T-i), being developed by Atkinson et al.(1), was employed to represent the indirect rock fracture toughness. The relationships between the SE and the large amounts of new data obtained from the mineralogical analyses, petrographic studies, rock mechanics, and linear rock cutting tests were evaluated by using bivariate correlation and curve fitting techniques, variance analysis, and Student's t-test. Rock cutting and rock property testing data that came from well-known studies of McFeat-Smith and Fowell(2) and Roxborough and Philips(3) have also been employed in statistical analyses together with the new data. Laboratory tests and subsequent analyses revealed that there were close correlations between the SE and B4 whereas no statistically significant correlation has been found between the SE and T-i. Uniaxial compressive and Brazilian tensile strengths and Shore scleroscope hardness of sandstones also exhibited strong relationships with the SE. NCB cone indenter test had the greatest influence on the SE among the other engineering properties of rocks, confirming the previous studies in rock cutting and mechanical excavation. Therefore, it was recommended to employ easy-to-use index tests of NCB cone indenter and Shore scleroscope in the estimation of laboratory SE of sandstones ranging from very low to high strengths in the absence of a rock cutting rig to measure it until the easy-to-use universal measures of the rock brittleness and especially the rock fracture toughness, being an intrinsic rock property, are developed.