Supervisor Continuity or Co-Location: Which Matters in Residency Education? Findings From a Qualitative Study of Remote Supervisor Family Physicians in Australia and Canada

Purpose: Changes to health care systems andworking hours have fragmentedresidents’ clinical experiences withpotentially negative effects ontheir development as professionals.Investigation of off-site supervision,which has been implemented in isolatedrural practice, could reveal importantbut less overt components of residencyeducation. 

Method: Insights from sociocultural learningtheory and work-based learning provideda theoretical framework. In 2011–2012,16 family physicians in Australia andCanada were asked in-depth how theyremotely supervised residents’ workand learning, and for their reflectionson this experience. The verbatiminterview transcripts and researchers’memos formed the data set. Templateanalysis produced a description andinterpretation of remote supervision. 

Results: Thirteen Australian family physiciansfrom five states and one territory, andthree Canadians from one province,participated. The main themes werehow remoteness changed the dynamicsof care and supervision; the importanceof ongoing, holistic, nonhierarchical,supportive supervisory relationships; andthat residents learned “clinical courage”through responsibility for patients’ careover time. Distance required supervisorsto articulate and pass on their expertiseto residents but made monitoringdifficult. Supervisory continuityencouraged residents to build on pastexperiences and confront deficiencies. 

Conclusions: Remote supervision enabled residents todevelop as clinicians and professionals.This questions the supremacy of co-locationas an organizing principle forresidency education. Future specialists maybenefit from programs that give themongoing and increasing responsibilityfor a group of patients and supportive.

Precision dating of the Palaeolithic: A new radiocarbon chronology for the Abri Pataud (France), a key Aurignacian sequence

This paper presents a new series of AMS dates on ultrafiltered bone gelatin extracted from identified cutmarked or humanly-modified bones and teeth from the site of Abri Pataud, in the French Dordogne. The sequence of 32 new determinations provides a coherent and reliable chronology from the site's early Upper Palaeolithic levels 5-14, excavated by Hallam Movius. The results show that there were some problems with the previous series of dates, with many underestimating the real age. The new results, when calibrated and modelled using a Bayesian statistical method, allow detailed understanding of the pace of cultural changes within the Aurignacian I and II levels of the site, something not achievable before. In the future, the sequence of dates will allow wider comparison to similarly dated contexts elsewhere in Europe. High precision dating is only possible by using large suites of AMS dates from humanly-modified material within well understood archaeological sequences modelled using a Bayesian statistical method. © 2011.

Inferring and Exploiting Categories for Next Location Prediction

Predicting the next location of a user based on their previous visiting pattern is one of the primary tasks over data from location based social networks (LBSNs) such as Foursquare. Many different aspects of these so-called “check-in” profiles of a user have been made use of in this task, including spatial and temporal information of check-ins as well as the social network information of the user. Building more sophisticated prediction models by enriching these check-in data by combining them with information from other sources is challenging due to the limited data that these LBSNs expose due to privacy concerns. In this paper, we propose a framework to use the location data from LBSNs, combine it with the data from maps for associating a set of venue categories with these locations. For example, if the user is found to be checking in at a mall that has cafes, cinemas and restaurants according to the map, all these information is associated. This category information is then leveraged to predict the next checkin location by the user. Our experiments with publicly available check-in dataset show that this approach improves on the state-of-the-art methods for location prediction.

Personalised and Precision Medicine in Cancer Clinical Trials: Panacea for Progress or Pandora's Box?

Cancer clinical trials have been one of the key foundations for significant advances in oncology. However, there is a clear recognition within the academic, care delivery and pharmaceutical/biotech communities that our current model of clinical trial discovery and development is no longer fit for purpose. Delivering transformative cancer care should increasingly be our mantra, rather than maintaining the status quo of, at best, the often miniscule incremental benefits that are observed with many current clinical trials. As we enter the era of precision medicine for personalised cancer care (precision and personalised medicine), it is important that we capture and utilise our greater understanding of the biology of disease to drive innovative approaches in clinical trial design and implementation that can lead to a step change in cancer care delivery. A number of advances have been practice changing (e.g. imatinib mesylate in chronic myeloid leukaemia, Herceptin in erb-B2-positive breast cancer), and increasingly we are seeing the promise of a number of newer approaches, particularly in diseases like lung cancer and melanoma. Targeting immune checkpoints has recently yielded some highly promising results. New algorithms that maximise the effectiveness of clinical trials, through for example a multi-stage, multi-arm type design are increasingly gaining traction. However, our enthusiasm for the undoubted advances that have been achieved are being tempered by a realisation that these new approaches may have significant cost implications. This article will address these competing issues, mainly from a European perspective, highlight the problems and challenges to healthcare systems and suggest potential solutions that will ensure that the cost/value rubicon is addressed in a way that allows stakeholders to work together to deliver optimal cost-effective cancer care, the benefits of which can be transferred directly to our patients.

An evaluation of portion size estimation aids precision, ease of use and likelihood of future use

OBJECTIVE: The present study aimed to evaluate the precision, ease of use and likelihood of future use of portion size estimation aids (PSEA).

DESIGN: A range of PSEA were used to estimate the serving sizes of a range of commonly eaten foods and rated for ease of use and likelihood of future usage.

SETTING: For each food, participants selected their preferred PSEA from a range of options including: quantities and measures; reference objects; measuring; and indicators on food packets. These PSEA were used to serve out various foods (e.g. liquid, amorphous, and composite dishes). Ease of use and likelihood of future use were noted. The foods were weighed to determine the precision of each PSEA.

SUBJECTS: Males and females aged 18-64 years (n 120).

RESULTS: The quantities and measures were the most precise PSEA (lowest range of weights for estimated portion sizes). However, participants preferred household measures (e.g. 200 ml disposable cup) - deemed easy to use (median rating of 5), likely to use again in future (all scored either 4 or 5 on a scale from 1='not very likely' to 5='very likely to use again') and precise (narrow range of weights for estimated portion sizes). The majority indicated they would most likely use the PSEA preparing a meal (94 %), particularly dinner (86 %) in the home (89 %; all P<0·001) for amorphous grain foods.

CONCLUSIONS: Household measures may be precise, easy to use and acceptable aids for estimating the appropriate portion size of amorphous grain foods.

The Effect of Seat Location in Lecture Theatres on Academic Performance

The purpose of this research study was to investigate and identify possible patterns relating to academic performance on the effects of university students self-selecting where to sit in a lecture theatre.
The key research questions are:
1. Does seating position affect student performance?
2. Do the most academically able and engaged students regularly sit at the front of lecture theatres?
Academic achievement
Preliminary results suggest significant assessment score differences between those that sit at the front and those that sit further the back. Of those that received a grade of 75%+ (Grade A) 6.67% regularly sat at the back. With the same group 46.67% regularly sat at the front. Of the group that scored less than 50% (Grade D) 0% of students regularly sat at the front. 12.50% regularly sat in the middle zones with 37.50% sitting at the back. It was also observed that the remaining numbers did not consistently sit in the same zone.

Temporal movement
There is little evidence of movement between seating zones of the Grade A group throughout the 24 week period. However there was considerable movement with the Grade D group. Although still under analysis there appears be a pattern of students in this group graduating towards the back seating positions over the course of the programme.

Engagement
The frequency of completed entries on PinPoint was also used as an indicator of engagement. With the Grade A group 75% of them regularly completed an entry whereas in the Grade D group this drops to less than 50%.
Further analysis on the attitudinal factors in relational to seating position and performance are ongoing, but preliminary results suggest that those students that scored highly in attitude tended to sit at the front and middle sections.
It would indeed appear that the more highly engaged and academically capable students voluntarily sit at the front for most lectures. Interestingly as the course progresses those who had lesser engagement and below average midterm results tend to began to sit progressively toward the back. If this is a repeatable pattern then a linear regression analysis of the seating positions and midterm results could help predict students in danger of failing.

Location-routing problems of semi-obnoxious facilities: approaches and decision support

A presente tese resulta de um trabalho de investigação cujo objectivo se centrou no problema de localização-distribuição (PLD) que pretende abordar, de forma integrada, duas actividades logísticas intimamente relacionadas: a localização de equipamentos e a distribuição de produtos. O PLD, nomeadamente a sua modelação matemática, tem sido estudado na literatura, dando origem a diversas aproximações que resultam de diferentes cenários reais. Importa portanto agrupar as diferentes variantes por forma a facilitar e potenciar a sua investigação. Após fazer uma revisão e propor uma taxonomia dos modelos de localização-distribuição, este trabalho foca-se na resolução de alguns modelos considerados como mais representativos. É feita assim a análise de dois dos PLDs mais básicos (os problema capacitados com procura nos nós e nos arcos), sendo apresentadas, para ambos, propostas de resolução. Posteriormente, é abordada a localização-distribuição de serviços semiobnóxios. Este tipo de serviços, ainda que seja necessário e indispensável para o público em geral, dada a sua natureza, exerce um efeito desagradável sobre as comunidades contíguas. Assim, aos critérios tipicamente utilizados na tomada de decisão sobre a localização destes serviços (habitualmente a minimização de custo) é necessário adicionar preocupações que reflectem a manutenção da qualidade de vida das regiões que sofrem o impacto do resultado da referida decisão. A abordagem da localização-distribuição de serviços semiobnóxios requer portanto uma análise multi-objectivo. Esta análise pode ser feita com recurso a dois métodos distintos: não interactivos e interactivos. Ambos são abordados nesta tese, com novas propostas, sendo o método interactivo proposto aplicável a outros problemas de programação inteira mista multi-objectivo. Por último, é desenvolvida uma ferramenta de apoio à decisão para os problemas abordados nesta tese, sendo apresentada a metodologia adoptada e as suas principais funcionalidades. A ferramenta desenvolvida tem grandes preocupações com a interface de utilizador, visto ser direccionada para decisores que tipicamente não têm conhecimentos sobre os modelos matemáticos subjacentes a este tipo de problemas.

Ultrasonic location system

Esta tese apresenta um sistema de localização baseado exclusivamente em ultrassons, não necessitando de recorrer a qualquer outra tecnologia. Este sistema de localização foi concebido para poder operar em ambientes onde qualquer outra tecnologia não pode ser utilizada ou o seu uso está condicionado, como são exemplo aplicações subaquáticas ou ambientes hospitalares. O sistema de localização proposto faz uso de uma rede de faróis fixos permitindo que estações móveis se localizem. Devido à necessidade de transmissão de dados e medição de distâncias foi desenvolvido um pulso de ultrassons robusto a ecos que permite realizar ambas as tarefas com sucesso. O sistema de localização permite que as estações móveis se localizem escutando apenas a informação em pulsos de ultrassons enviados pelos faróis usando para tal um algoritmo baseado em diferenças de tempo de chegada. Desta forma a privacidade dos utilizadores é garantida e o sistema torna-se completamente independente do número de utilizadores. Por forma a facilitar a implementação da rede de faróis apenas será necessário determinar manualmente a posição de alguns dos faróis, designados por faróis âncora. Estes irão permitir que os restantes faróis, completamente autónomos, se possam localizar através de um algoritmo iterativo de localização baseado na minimização de uma função de custo. Para que este sistema possa funcionar como previsto será necessário que os faróis possam sincronizar os seus relógios e medir a distância entre eles. Para tal, esta tese propõe um protocolo de sincronização de relógio que permite também obter as medidas de distância entre os faróis trocando somente três mensagens de ultrassons. Adicionalmente, o sistema de localização permite que faróis danificados possam ser substituídos sem comprometer a operabilidade da rede reduzindo a complexidade na manutenção. Para além do mencionado, foi igualmente implementado um simulador de ultrassons para ambientes fechados, o qual provou ser bastante preciso e uma ferramenta de elevado valor para simular o comportamento do sistema de localização sobre condições controladas.

Cooperative positioning for heterogeneous wireless systems

Future emerging market trends head towards positioning based services placing a new perspective on the way we obtain and exploit positioning information. On one hand, innovations in information technology and wireless communication systems enabled the development of numerous location based applications such as vehicle navigation and tracking, sensor networks applications, home automation, asset management, security and context aware location services. On the other hand, wireless networks themselves may bene t from localization information to improve the performances of di erent network layers. Location based routing, synchronization, interference cancellation are prime examples of applications where location information can be useful. Typical positioning solutions rely on measurements and exploitation of distance dependent signal metrics, such as the received signal strength, time of arrival or angle of arrival. They are cheaper and easier to implement than the dedicated positioning systems based on ngerprinting, but at the cost of accuracy. Therefore intelligent localization algorithms and signal processing techniques have to be applied to mitigate the lack of accuracy in distance estimates. Cooperation between nodes is used in cases where conventional positioning techniques do not perform well due to lack of existing infrastructure, or obstructed indoor environment. The objective is to concentrate on hybrid architecture where some nodes have points of attachment to an infrastructure, and simultaneously are interconnected via short-range ad hoc links. The availability of more capable handsets enables more innovative scenarios that take advantage of multiple radio access networks as well as peer-to-peer links for positioning. Link selection is used to optimize the tradeo between the power consumption of participating nodes and the quality of target localization. The Geometric Dilution of Precision and the Cramer-Rao Lower Bound can be used as criteria for choosing the appropriate set of anchor nodes and corresponding measurements before attempting location estimation itself. This work analyzes the existing solutions for node selection in order to improve localization performance, and proposes a novel method based on utility functions. The proposed method is then extended to mobile and heterogeneous environments. Simulations have been carried out, as well as evaluation with real measurement data. In addition, some speci c cases have been considered, such as localization in ill-conditioned scenarios and the use of negative information. The proposed approaches have shown to enhance estimation accuracy, whilst signi cantly reducing complexity, power consumption and signalling overhead.

Looking behaviour and preference for artworks: The role of emotional valence and location

The position of an item influences its evaluation, with research consistently finding that items occupying central locations are preferred and have a higher subjective value. The current study investigated whether this centre-stage effect (CSE) is a result of bottom-up gaze allocation to the central item, and whether it is affected by item valence. Participants (n=50) were presented with three images of artistic paintings in a row and asked to choose the image they preferred. Eye movements were recorded for a subset of participants (n=22). On each trial the three artworks were either similar but different, or were identical and with positive valence, or were identical and with negative valence. The results showed a centre-stage effect, with artworks in the centre of the row preferred, but only when they were identical and of positive valence. Significantly greater gaze allocation to the central and left artwork was not mirrored by equivalent increases in preference choices. Regression analyses showed that when the artworks were positive and identical the participants’ last fixation predicted preference for the central art-work, whereas the fixation duration predicted preference if the images were different. Overall the result showed that item valence, rather than level of gaze allocation, influences the CSE, which is incompatible with the bottom-up gaze explanation. We propose that the centre stage heuristic, which specifies that the best items are in the middle, is able to explain these findings and the centre-stage effect.