Telling the truth: medical students' progress with an ethical skill.

BACKGROUND: Truth-telling is a complex task requiring multiple skills in communication, understanding, and empathy. Its application in the context of breaking bad news (BBN) is distressing and problematic if conducted with insufficient skills. PURPOSE: We investigated the long-term influence of a simulated patient-based teaching intervention integrating the learning of communication skills within an ethical reflection on students' ethical attitudes towards truth-telling, perceived competence and comfort in BBN. METHODS: We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). We analysed their ethical attitudes and level of comfort and competence in BBN before, after the intervention, and during clinical rotations. RESULTS: Students' ethical attitudes towards truth-telling remained stable. Students feeling uncomfortable or incompetent improved their level of perceived comfort or competence after the intervention, but those feeling comfortable or competent became more aware of the difficulty of the situation, and consequently decreased their level of comfort and competence. CONCLUSIONS: Confronting students with a realistic situation and integrating the practice of communication skills within an ethical reflection may be effective in maintaining ethical attitudes towards truth-telling, in developing new skills and increasing awareness about the difficulty and challenges of a BBN situation.

Evaluation of Rumble Stripes on Low-Volume Rural Roads in Iowa—Phase II Final Report, November 2011

Single-vehicle run-off-road crashes are the most common crash type on rural two-lane Iowa roads. Rumble strips have proven effective in mitigating these crashes, but the strips are commonly installed in paved shoulders on higher-volume roads that are owned by the State of Iowa. Lower-volume paved rural roads owned by local agencies do not commonly feature paved shoulders but frequently experience run-off-road crashes. This project involved installing rumble stripes, which are a combination of conventional rumble strips with a painted edge line placed on the surface of the milled area, along the edge of the travel lanes, but at a narrow width to avoid possible intrusion into the normal vehicle travel paths. The research described in this report was part of a project funded by the Federal Highway Administration, Iowa Highway Research Board, and Iowa Department of Transportation to evaluate the effectiveness of edge-line rumble strips in Iowa. The project evaluated the effectiveness of rumble stripes in reducing run-off-road crashes and in improving the longevity and wet-weather visibility of edge-line markings. This project consisted of two phases. The first phase was to select pilot study locations, select a set of test sites, install rumble stripes, summarize lessons learned during installation, and provide a preliminary assessment of the rumble stripes’ performance. The purpose of this report was to document results from Phase II. A before and after crash analysis was conducted to assess whether use of the treatment had resulted in fewer crashes. However, due to low sample size, results of the analysis were inconclusive. Lateral position was also evaluated before and after installation of the treatment to determine whether vehicles engaged in better lane keeping. Pavement marking wear was also assessed.

Roadway Design Standards for Rural and Suburban Subdivisions Final Report, June 2007

In Iowa, there are currently no uniform design standards for rural and suburban subdivision development roadways. Without uniform design standards, many counties are unable to provide adequate guidance for public facilities, particularly roadways, to be constructed as part of a rural subdivision development. If a developer is not required to install appropriate public improvements or does not do so properly, significant liability and maintenance expenses can be expected, along with the potential for major project costs to correct the situation. Not having uniform design standards for rural and suburban subdivision development improvements in Iowa creates situations where there is potential for inconsistency and confusion. Differences in the way development standards are applied also create incentives or disincentives for developers to initiate subdivision platting in a particular county. With the wide range of standards or lack of standards for local roads in development areas, it is critical that some level of uniformity is created to address equity in development across jurisdictional lines. The standards must be effective in addressing the problem, but they must not be so excessive as to curtail development activities within a local jurisdiction. In order to address the concerns, cities and counties have to work together to identify where growth is going to be focused. Within that long-term growth area, the roadways should be constructed to urban standards to provide an easier transition to traditional urban facilities as the area is developed. Developments outside of the designated growth area should utilize a rural cross section since it is less likely to have concentrated urban development. The developers should be required to develop roadways that are designed for a minimum life of 40 years, and the county should accept dedication of the roadway and be responsible for its maintenance.

Audit report on the Xenia Rural Water District for the year ended December 31, 2011

Audit report on the Xenia Rural Water District for the year ended December 31, 2011

Penser la médecine communautaire s'apprend avec les pairs. [The spirit of community medicine: students learning from students].

At the University of Lausanne third-year medical students are given the task of spending a month investigating a question of community medicine. In 2009, four students evaluated the legitimacy of health insurers intervening in the management of depression. They found that health insurers put pressure on public authorities during the development of legislation governing the health system and reimbursement for treatment. This fact emerged during the scientific investigation led jointly by the team in the course of the "module of immersion in community medicine." This paper presents each step of their study. The example chosen illustrates the learning objectives covered by the module.

Measuring alcohol-related consequences in school surveys: alcohol-attributable consequences or consequences with students' alcohol attribution.

In alcohol epidemiology surveys, there is a tradition of measuring alcohol-related consequences using respondents' attribution of alcohol as the cause. The authors aimed to compare the prevalence and frequency of self-attributed consequences to consequences without self-attribution using alcohol-attributable fractions (AAF). In 2007, a total of 7,174 Swiss school students aged 13-16 years reported the numbers of 6 alcohol-related adverse consequences (e.g., fights, injuries) they had incurred in the past 12 months. Consequences were measured with and without attribution of alcohol as the cause. The alcohol-use measures were frequency and volume of drinking in the past 12 months and number of risky single-occasion (> or =5 drinks) drinking episodes in the past 30 days. Attributable fractions were derived from logistic (> or =1 incident) and Poisson (number of incidents) regression analyses. Although relative risk estimates were higher when alcohol-attributed consequences were compared with nonattributed consequences, the use of AAFs resulted in more alcohol-related consequences (10,422 self-attributed consequences vs. 24,520 nonattributed consequences determined by means of AAFs). The likelihood of underreporting was higher among drinkers with intermediate frequencies than among either rare drinkers or frequent drinkers. Therefore, the extent of alcohol-related adverse consequences among adolescents may be underestimated when using self-attributed consequences, because of differential attribution processes, especially among infrequent drinkers.

IOWA Students with Autism: Who are they, how are they served, and are they achieving? October 2012

The Iowa Department of Education completed two studies in 2011-2012. The studies addressed several areas of need: (a) identifying students likely on the Autism Spectrum, (b) examining where large numbers of students on the Autism Spectrum are attending school, (c) evaluating the services being provided to students and the location of those services, (d) determining the extent to which services are evidence-based, (e) determining if services are sufficient to effect change needed to reach performance levels needed to access life opportunity, (f) understanding the kinds of problems being addressed through the Individualized Education Programs (IEPs) for the students identified, (g) examining the severity of behavior problems in the sample, and (h) examining academic proficiency and growth for students likely to be on the Autism Spectrum.

Prevalence of articular chondrocalcinosis in elderly subjects in a rural area of Catalonia

The occurrence of rheumatic disorders did not differ significantly between subjects with articular chondrocalcinosis and those without. CONCLUSIONS--Articular chondrocalcinosis is an age related disorder, which could partly explain the discrepancies in its prevalence reported in previous studies. In most subjects with articular chondrocalcinosis recruited from an unselected population the clinical manifestations are probably mild or even absent.

Performance anxiety : cardiorespiratory activity in high- and low-anxious professional music students in a performance situation

Questionnaire studies indicate that high-anxious musicians may suffer from hyperventilation symptoms before and/or during performance. Reported symptoms include amongst others shortness of breath, fast or deep breathing, dizziness and thumping heart. A self-report study by Widmer, Conway, Cohen and Davies (1997) shows that up to seventy percent of the tested highly anxious musicians are hyperventilators during performance. However, no study has yet tested if these self-reported symptoms reflect actual cardiorespiratory changes just before and during performance. Disturbances in breathing patterns and hyperventilation may negatively affect the performance quality in stressful performance situations. The main goal of this study is to determine if music performance anxiety is manifest physiologically in specific correlates of cardiorespiratory activity. We studied 74 professional music students of Swiss Music Universities divided into two groups (high- and lowanxious) based on their self-reported performance anxiety (State-Trait Anxiety Inventory by Spielberger). The students were tested in three distinct situations: baseline, performance without audience, performance with audience. We measured a) breathing patterns, end-tidal carbon dioxide, which is a good non-invasive estimator for hyperventilation, and cardiac activation and b) self-perceived emotions and self-perceived physiological activation. Analyses of heart rate, respiratory rate, self-perceived palpitations, self-perceived shortness of breath and self-perceived anxiety for the 15 most and the 15 least anxious musicians show that high-anxious and low-anxious music students have a comparable physiological activation during the different measurement periods. However, highanxious music students feel significantly more anxious and perceive significantly stronger palpitations and significantly stronger shortness of breath just before and during a public performance. The results indicate that low- and high-anxious music students a) do not differ in the considered physiological responses and b) differ in the considered self-perceived physiological symptoms and the selfreported anxiety before and/or during a public performance.

Rural Expressway Intersection Safety Toolbox Desktop Reference, June 17, 2011

This document is intended to be a guide for planning-level decisions concerning safety issues and subsequent potential improvements at rural expressway intersections. It is NOT a design guide. It simply presents the gamut of safety treatment options and available strategies that have been employed in an attempt to reduce the number and severity of collisions at unsignalized rural expressway intersections.

Audit report on the Xenia Rural Water District for the year ended December 31, 2012

Audit report on the Xenia Rural Water District for the year ended December 31, 2012

Toolbox of Countermeasures for Rural Two-Lane Curves, June 2012

The Federal Highway Administration (FHWA) estimates that 58 percent of roadway fatalities are lane departures, while 40 percent of fatalities are single-vehicle run-off-road (SVROR) crashes. Addressing lane-departure crashes is therefore a priority for national, state, and local roadway agencies. Horizontal curves are of particular interest because they have been correlated with increased crash occurrence. This toolbox was developed to assist agencies address crashes at rural curves. The main objective of this toolbox is to summarize the effectiveness of various known curve countermeasures. While education, enforcement, and policy countermeasures should also be considered, they were not included given the toolbox focuses on roadway-based countermeasures. Furthermore, the toolbox is geared toward rural two-lane curves. The research team identified countermeasures based on their own research, through a survey of the literature, and through discussions with other professionals. Coverage of curve countermeasures in this toolbox is not necessarily comprehensive. For each countermeasure covered, this toolbox includes the following information: description, application, effectiveness, advantages, and disadvantages.

Evaluation of Low Cost Traffic Calming for Rural Communities – Phase II, April 2013

The main goal of the research described in this report was to evaluate countermeasures that agencies can use to reduce speeds as drivers enter rural communities located on high-speed roadways. The objectives of this study were as follows: * Identify and summarize countermeasures used to manage speeds in transition zones * Demonstrate the effectiveness of countermeasures that are practical for high- to low-speed transition zones * Acquire additional information about countermeasures that may show promise but lack sufficient evidence of effectiveness * Develop an application toolbox to assist small communities in selecting appropriate transition zones and effective countermeasures for entrances to small rural communities The team solicited small communities that were interested in participating in the Phase II study and several communities were also recommended. The treatments evaluated were selected by carefully considering traffic-calming treatments that have been used effectively in other countries for small rural communities, as well as the information gained from the first phase of the project. The treatments evaluated are as follows: * Transverse speed bars * Colored entrance treatment * Temporary island * Radar-activated speed limit sign * Speed feedback sign The toolbox publication and four focused tech briefs also cover the results of this work.