Sustained impact of a short small group course with systematic feedback in addition to regular clinical clerkship activities on musculoskeletal examination skills-a controlled study.

BACKGROUND The discrepancy between the extensive impact of musculoskeletal complaints and the common deficiencies in musculoskeletal examination skills lead to increased emphasis on structured teaching and assessment. However, studies of single interventions are scarce and little is known about the time-dependent effect of assisted learning in addition to a standard curriculum. We therefore evaluated the immediate and long-term impact of a small group course on musculoskeletal examination skills. METHODS All 48 Year 4 medical students of a 6 year curriculum, attending their 8 week clerkship of internal medicine at one University department in Berne, participated in this controlled study. Twenty-seven students were assigned to the intervention of a 6×1 h practical course (4-7 students, interactive hands-on examination of real patients; systematic, detailed feedback to each student by teacher, peers and patients). Twenty-one students took part in the regular clerkship activities only and served as controls. In all students clinical skills (CS, 9 items) were assessed in an Objective Structured Clinical Examination (OSCE) station, including specific musculoskeletal examination skills (MSES, 7 items) and interpersonal skills (IPS, 2 items). Two raters assessed the skills on a 4-point Likert scale at the beginning (T0), the end (T1) and 4-12 months after (T2) the clerkship. Statistical analyses included Friedman test, Wilcoxon rank sum test and Mann-Whitney U test. RESULTS At T0 there were no significant differences between the intervention and control group. At T1 and T2 the control group showed no significant changes of CS, MSES and IPS compared to T0. In contrast, the intervention group significantly improved CS, MSES and IPS at T1 (p < 0.001). This enhancement was sustained for CS and MSES (p < 0.05), but not for IPS at T2. CONCLUSIONS Year 4 medical students were incapable of improving their musculoskeletal examination skills during regular clinical clerkship activities. However, an additional small group, interactive clinical skills course with feedback from various sources, improved these essential examination skills immediately after the teaching and several months later. We conclude that supplementary specific teaching activities are needed. Even a single, short-lasting targeted module can have a long lasting effect and is worth the additional effort.

Medical educators: How they define themselves - Results of an international web survey.

BACKGROUND Little is known about medical educators' self-definition. AIMS The aim of this study is to survey an international community of medical educators focusing on the medical educators' self-definition. METHODS Within a comprehensive, web-based survey, an open question on the participants' views of how they would define a "medical educator" was sent to 2200 persons on the mailing list of the Association for Medical Education in Europe. The free text definitions were analysed using qualitative thematic analysis. RESULTS Of the, 200 medical educators invited to participate, 685 (31.1%) provided a definition of a "medical educator". The qualitative analysis of the free text definitions revealed that medical educators defined themselves in 13 roles, primarily as "Professional Expert", "Facilitator", "Information Provider", "Enthusiast", "Faculty Developer", "Mentor", "Undergraduate and Postgraduate Trainer", "Curriculum Developer", "Assessor and Assessment Creator", and "Researcher". CONCLUSIONS Our survey revealed that medical educators predominantly define themselves as "Professional Experts" and identified 12 further self-defined roles of a medical educator, several of which not to have been reported previously. The results can be used to further the understanding of our professional identity.

Simultaneous multi-slice readout-segmented echo planar imaging for accelerated diffusion-weighted imaging of the breast

OBJECTIVES Readout-segmented echo planar imaging (rs-EPI) significantly reduces susceptibility artifacts in diffusion-weighted imaging (DWI) of the breast compared to single-shot EPI but is limited by longer scan times. To compensate for this, we tested a new simultaneous multi-slice (SMS) acquisition for accelerated rs-EPI. MATERIALS AND METHODS After approval by the local ethics committee, eight healthy female volunteers (age, 38.9±13.1 years) underwent breast MRI at 3T. Conventional as well as two-fold (2× SMS) and three-fold (3× SMS) slice-accelerated rs-EPI sequences were acquired at b-values of 50 and 800s/mm(2). Two independent readers analyzed the apparent diffusion coefficient (ADC) in fibroglandular breast parenchyma. The signal-to-noise ratio (SNR) was estimated based on the subtraction method. ADC and SNR were compared between sequences by using the Friedman test. RESULTS The acquisition time was 4:21min for conventional rs-EPI, 2:35min for 2× SMS rs-EPI and 1:44min for 3× SMS rs-EPI. ADC values were similar in all sequences (mean values 1.62×10(-3)mm(2)/s, p=0.99). Mean SNR was 27.7-29.6, and no significant differences were found among the sequences (p=0.83). CONCLUSION SMS rs-EPI yields similar ADC values and SNR compared to conventional rs-EPI at markedly reduced scan time. Thus, SMS excitation increases the clinical applicability of rs-EPI for DWI of the breast.

Metal Artifact Reduction in Pelvic Computed Tomography With Hip Prostheses: Comparison of Virtual Monoenergetic Extrapolations From Dual-Energy Computed Tomography and an Iterative Metal Artifact Reduction Algorithm in a Phantom Study.

OBJECTIVE The aim of this study was to directly compare metal artifact reduction (MAR) of virtual monoenergetic extrapolations (VMEs) from dual-energy computed tomography (CT) with iterative MAR (iMAR) from single energy in pelvic CT with hip prostheses. MATERIALS AND METHODS A human pelvis phantom with unilateral or bilateral metal inserts of different material (steel and titanium) was scanned with third-generation dual-source CT using single (120 kVp) and dual-energy (100/150 kVp) at similar radiation dose (CT dose index, 7.15 mGy). Three image series for each phantom configuration were reconstructed: uncorrected, VME, and iMAR. Two independent, blinded radiologists assessed image quality quantitatively (noise and attenuation) and subjectively (5-point Likert scale). Intraclass correlation coefficients (ICCs) and Cohen κ were calculated to evaluate interreader agreements. Repeated measures analysis of variance and Friedman test were used to compare quantitative and qualitative image quality. Post hoc testing was performed using a corrected (Bonferroni) P < 0.017. RESULTS Agreements between readers were high for noise (all, ICC ≥ 0.975) and attenuation (all, ICC ≥ 0.986); agreements for qualitative assessment were good to perfect (all, κ ≥ 0.678). Compared with uncorrected images, VME showed significant noise reduction in the phantom with titanium only (P < 0.017), and iMAR showed significantly lower noise in all regions and phantom configurations (all, P < 0.017). In all phantom configurations, deviations of attenuation were smallest in images reconstructed with iMAR. For VME, there was a tendency toward higher subjective image quality in phantoms with titanium compared with uncorrected images, however, without reaching statistical significance (P > 0.017). Subjective image quality was rated significantly higher for images reconstructed with iMAR than for uncorrected images in all phantom configurations (all, P < 0.017). CONCLUSIONS Iterative MAR showed better MAR capabilities than VME in settings with bilateral hip prosthesis or unilateral steel prosthesis. In settings with unilateral hip prosthesis made of titanium, VME and iMAR performed similarly well.

Pelvic floor muscle electromyography during different running speeds: an exploratory and reliability study.

PURPOSE Stress urinary incontinence (SUI) affects women of all ages including young athletes, especially those involved in high-impact sports. To date, hardly any studies are available testing pelvic floor muscles (PFM) during sports activities. The aim of this study was the description and reliability test of six PFM electromyography (EMG) variables during three different running speeds. The secondary objective was to evaluate whether there was a speed-dependent difference between the PFM activity variables. METHODS This trial was designed as an exploratory and reliability study including ten young healthy female subjects to characterize PFM pre-activity and reflex activity during running at 7, 9 and 11 km/h. Six variables for each running speed, averaged over ten steps per subject, were presented descriptively, tested regarding their reliability (Friedman, ICC, SEM, MD) and speed difference (Friedman). RESULTS PFM EMG variables varied between 67.6 and 106.1 %EMG, showed no systematic error and were low for SEM and MD using the single value model. Applying the average model over ten steps, ICC (3,k) were >0.75 and SEM and MD about 50 % lower than for the single value model. Activity was found to be highest in 11 km/h. CONCLUSION EMG variables showed excellent ICC and very low SEM and MD. Further studies should investigate inter-session reliability and PFM reactivity patterns of SUI patients using the average over ten steps for each variable as it showed very high ICC and very low SEM and MD. Subsequently, longer running distances and other high-impact sports disciplines could be studied.

Deep water provenance and dynamics of the (de)glacial Atlantic meridional overturning circulation

Reconstructing past modes of ocean circulation is an essential task in paleoclimatology and paleoceanography. To this end, we combine two sedimentary proxies, Nd isotopes (εNd) and the 231Pa/230Th ratio, both of which are not directly involved in the global carbon cycle, but allow the reconstruction of water mass provenance and provide information about the past strength of overturning circulation, respectively. In this study, combined 231Pa/230Th and εNd down-core profiles from six Atlantic Ocean sediment cores are presented. The data set is complemented by the two available combined data sets from the literature. From this we derive a comprehensive picture of spatial and temporal patterns and the dynamic changes of the Atlantic Meridional Overturning Circulation over the past ∼25 ka. Our results provide evidence for a consistent pattern of glacial/stadial advances of Southern Sourced Water along with a northward circulation mode for all cores in the deeper (>3000 m) Atlantic. Results from shallower core sites support an active overturning cell of shoaled Northern Sourced Water during the LGM and the subsequent deglaciation. Furthermore, we report evidence for a short-lived period of intensified AMOC in the early Holocene.

A study of oxygen isotopic fractionation during bio-induced calcite precipitation in eutrophic Baldeggersee, Switzerland

In order to better understand environmental factors controlling oxygen isotope shifts in autochthonous lacustrine carbonate sequences, we undertook an extensive one-year study (March, 1995 to February, 1996) of water-column chemistry and daily sediment trap material from a small lake in Central Switzerland. Comparisons between calculated equilibrium isotope values, using the fractionation equation of Friedman and O’Neil, (1977) and measured oxygen isotope ratios of calcite in the sediment-traps reveal that oxygen isotopic values of autochthonous calcite (δ18O) are in isotopic equilibrium with ambient water during most of the spring and summer, when the majority of the calcite precipitates. In contrast, small amounts of calcite precipitated in early-spring and again in late-autumn are isotopically depleted in 18O relative to the calculated equilibrium values, by as much as 0.8‰. This seasonally occurring apparent isotopic nonequilibrium is associated with times of high phosphorous concentrations, elevated pH (∼8.6) and increased [CO32−] (∼50 μmol/l) in the surface waters. The resulting weighted average δ18O value for the studied period is −9.6‰, compared with a calculated equilibrium δ18O value of −9.4‰. These data convincingly demonstrate that δ18O of calcite are, for the most part, a very reliable proxy for temperature and δ18O of the water.

Na 1 Nachlass Max Horkheimer, 15 - Korrespondenzen u.a. mit Hans Fried (p. I 8, 1-201)

11 Briefe zwischen Hans Fried und Max Horkheimer, 1938-1940; 1 Brief von Max Horkheimer an die Albert Teachers Agency New York, 21.03.1941; 2 Briefe zwischen dem American Committee for International Studies, Princeton, New York und Max Horkheimer, 11.01.1941, 16.01.1941; 1 Brief von Sullivan & Cromwell New York an Max Horkheimer, 18.03.1940; 12 Briefe zwischen der Columbia University in the City of New York und Max Horkheimer, 1938-1940; 2 Briefe von Hans Fried an die Columbia University in the City of New york, 1938-1939; 1 Brief von Max Horkheimer an das Emergency Committee in Aid of Displaced German Scholars New York; 2 Briefe zwischen der Ittleson Foundation New York und Max Horkheimer, 19.11.1938, 28.11.1938; 1 Brief von Max Goldschmidt an Hans Fried, 21.04.1938; 1 Brief von Max Horkheimer an Max Goldschmidt, 25.04.1938; 2 Briefe von Alice Friedlaender an Max Horkheimer, 1932, 1944; 3 Briefe zwischen Charles S. Friedman und Max Horkheimer, 21.03.1942, 1936, 1942; 4 Briefe von C. J. Friedrich an Max Horkheimer, 1941; 4 Briefe von Franz L. Neumann an C. J. Friedrich, 1941; 8 Briefe zwischen den Friends of Europe London und Max Horkheimer, 1934-1938; 3 Briefe von Max Horkheimer an John W. Fries, 1939; 2 Briefe von Gertrud Fries an Max Horkheimer, 1936; 1 Brief von Josef Fröbes an Max Horkheimer, 24.08.1937; 3 Briefe zwischen Fruin und Max Horkheimer, 1936; 14 Briefe zwischen Eduard Fuchs und Max Horkheimer, 1935-1939;

A comparison of two statistical methods for analysis of day of the week effect on births from 2005-2007 in Harris County of Texas

The pattern of the births during the week has been reported by many studies. The births occurred in weekends are found consistently less then births occurred in weekdays. This study employed two statistical methods, two-way ANOVA and two-way Friedman's test to analyse the daily variations in amount of births of 222,735 births from 2005-2007 in Harris County, Texas. The two methods were compared on their assumptions, procedures and results. Both of the tests showed a significant result which indicated that the births through the week are not uniformly distributed. The result of multiple comparison demonstrated the births occurring on weekends were significantly different than the births occurring on weekdays with least amount on Sundays.^

Why the Village is so Hard to Find: Challenging Ourselves, Transforming Our Helping Systems

Keynote address presented by Roger Friedman, PhD, LCSW at the Family Preservation Institute Annual Conference, San Antonio, Texas, September 9, 2004. Looking at Language and Concepts Looking closely at certain language that we use helps us understand how we think about our work and our world—and ultimately, it helps us understand ourselves better. The term "village " as used in the title of the paper and in many of our professional conversations is worthy of such an inquiry

Chemical composition of Lake George (New York) iron-manganese nodules and underlying sediment

Lake George, New York, is the site of a new discovery of iron-manganese nodules. These nodules occur at a water depth between 21 and 36 m along a stretch of lake extending for about 5 mi north and south of the Narrows, a constricted island-dotted area which separates the north and south Lake George basins. Nodules occur on or within the uppermost 5 cm of a varved glacial clay. Some areas are solidly floored with a carpet of nodules in areas where active currents keep the nodules exposed. The nodules form around nuclei which consist of clay and less commonly of spore capsules, detrital particles, or bark. By their shape we recognize three types of nodules: spherical, discoidal, and lumps. On X-ray examination all nodules show small goethite peaks; in one nodule the manganese mineral birnessite was identified. Manganese and part of the iron appears to be in X-ray amorphous ferromanganese compounds. The Lake George nodules are enriched in iron with respect to marine nodules but are lower in manganese. They have a higher trace element concentration than nodules from other known freshwater lake occurrences, but a lower concentration than marine nodules.

(Table 1) Description of structures in cores at DSDP Holes 59-451, 59-448A and 59-447A

Fifteen lengths of Leg 59 cores (primarily from Hole 451 as well as from Holes 447A and 448A) exhibiting macroscopic faults were selected by Dr. R. B. Scott (Co-Chief Scientist, Leg 59) to help us initiate this petrofabric analysis. We proposed to (1) determine what dynamically useful deformation features might be associated with the faults, and (2) infer from these features as much as possible about the physical environment of the deformation (effective pressure, differential stress, temperature, and strain rate), the orientation and relatively magnitudes of the principal stresses at the time of deformation, and the degree of induration of the rocks at the time of deformation. The cores, mainly from Hole 451, had been slabbed on board ship with respect to the trace of bedding so that each cut surface contains the true bedding dip-direction. In general, the cores from Hole 451 are largely calcareous, lithic and vitric, brecciated tuffs, whereas those from Holes 447A and 448A are basalts or basalt breccias.

Evaluación sensorial de mermeladas de tomate de color no tradicional

Nuevas cultivares de tomate, de colores distintos al tradicional rojo, se adaptan a la elaboración de productos alternativos, como las confituras. Se estudió la aceptabilidad por parte del consumidor de mermeladas elaboradas con las variedades Victoria FCA, Don Armando FCA y Santa Rosa FCA. Sus frutos: amarillos, anaranjados y rojos, respectivamente, fueron caracterizados por color, peso, acidez: titulable y potencial, y sólidos solubles. Las mermeladas, aromatizadas con clavo de olor, se elaboraron en una planta experimental hasta concentración 67-69 % de sólidos solubles. Un panel de 39 consumidores -clasificados en menores y mayores de 30 años- evaluó aspecto, color, aroma, textura y sabor, aplicando escalas no estructuradas. Las evaluaciones de ambos grupos fueron distintas. Para todas las características sensoriales la prueba de Friedman indicó diferencias entre los tres productos (a = 0,001). En una escala para cinco categorías, más del 50 % de los jueces consideraron las tres mermeladas en las categorías más altas: me gusta y me gusta mucho. El análisis de los datos categóricos de preferencia otorgó el primer lugar a la variedad roja, seguida por la anaranjada y la amarilla. Podría existir un segmento de consumidores interesados en el desarrollo de confituras de tomate amarillo, pero en el caso específico de la mermelada, tuvo mayor aceptabilidad el producto de color igual o parecido al tradicional.

Subprograma de salud bucal "El hospital y los chicos" : del diagnóstico del estado dental a la priorización de programas necesarios

Los objetivos de este trabajo fueron determinar el estado dental de la población bajo estudio, detectar subgrupos de riesgo específico para enfermedades bucales y proponer estrategias de intervención apropiadas para la promoción de la salud bucal para ellos. Método: sobre la base de datos del subprograma de salud bucal "El hospital y los chicos" se efectuó un estudio descriptivo del estado dental sobre 277 niños entre 2 meses y 13 años de edad asistentes al CDlF Nº11, Guaymallén, Mendoza. Se registraron: ceod, CPOD, ceos CPOS, índice de Necesidad de tratamiento de caries, índice de Paca de Silness y Loe, ICDAS II, y datos demográficos. Además, como parte del programa, se llevó a cabo la enseñanza de Técnicas de Higiene Bucal adecuada a la edad, dirigidas a madres y niños, y una topicación de flúor profesional siguiendo protocolos específicos según edad del niño. Resultados: la población libre de caries fue del 31,4%, mientras que el 68,6% tuvo experiencia de caries pasada o presente. La media de la sumatoria de ceod+ cpod fue 4,91 = 5, con una carga de enfermedad muy alta denotada por un componente c+C de 4.25=4.55. Presentó un valor para ceos+CPOS de 9,22+11 96 y de c+CS de 6.8918 61. En cuanto a la severidad de las lesiones de caries expresadas con las categorías de ICDAS II del 2 al 6, se observó que las medias mayores corres- , ponden al nivel 6 (x2 Friedman= 20,999, p= 0,000). La media de necesidad de tratamiento de caries fue de 5,74, pero los niveles 8 y más abarcan al 33.2% de la población de estudio Se observó un aumento progresivo de estos indicadores en la primera infancia comenzando en la primera franja etaria con una media de ceod+CPOD de 0.8811,92, de 3, 93t4.65a los tres años, de 6,38+6,36 a los 5 años, y de 8,40+5,47 a los 7 años, siendo esta población la que presentó el mayor valor del indicador (x2 Kruskall Wallis= 104,637, p=O,OO). El índice CPOD fue de 1,35~1,34 a los 7 años y de 4.65+3 99 a los 9 ( x2 Kruskall Wallis =17,609 y p=0,001) Conclusiones~ este grupo de niños de alto riesgo social presentó elevados índices de caries y de necesidad de tratamiento, que requerirán de un sistema de salud que pueda contenerlos. Al observar las medias de ceod+CPOD según las categorías de edad se pone de manifiesto una tendencia a agravarse el estado dentario en la primera infancia, llegando a valores muy por encima de la media general para los 5, 6 ,7 y 8 años El CEOD también tiende a aumentar con la edad, poniendo en evidencia la susceptibilidad de caries de los molares permanentes erupcionados Las tendencias de los indicadores permitieron reconocer dos subgrupos de riesgo para desarrollar programas preventivos' el de niños de O a 3 años, y el de 6 a 12, es decir niños escolares. Se sugieren dos programas prioritarios Materno- infantil y Protección de 1er molar permanente.