The GC Immersive: Patching the pipeline with genetic counseling experiences for all

Genetic counseling graduate programs largely recommend that prospective applicants shadow or gain exposure to genetic counselors (GC) as a means of developing insight into the profession. However, prospective students have cited this need to shadow genetic counselors as harder to access in comparison to other prerequisites. The GC Immersive (GCI) at Color was created as a no-cost, remote, self-paced professional exploration program designed to provide resources and live interaction with a team of genetic counselors to increase accessibility to GC exposure and enhance the competitiveness of underrepresented GC candidates. The program design and curriculum were developed by a team of certified genetic counselors and a GC student in 2021 and is marketed to those who have one or more identities underrepresented in the GC field. In total, 287 individuals enrolled in the program in the first and second cycles, with 115 providing demographic information. The majority of enrollees identified as an underrepresented minority in GC in one or more identities, with individuals who are ethnic and/or racial minority (70%), first-generation college student (44%), lesbian, gay, transgender, queer, intersex, and/or asexual (LGBTQIA+) (27%), and disabled community (16%) reported as the most common identities. Most participants had never shadowed a GC (55%) prior to this course. Twenty-two percent of enrollees resided outside of the United States, representing 15 different countries. Of the 287 enrolled participants, 21 (7%) have completed the program, with the remaining participants having between 5 and 11 months to complete. All individuals who completed the program reported they felt better prepared to apply for a GC program. The general structure of this program can be replicated by any institution, as the program consists primarily of recorded content. Ongoing effort by genetic counselors is minimal and has the ability to provide GC experience to prospective applicants at great scale.

Machine-Learning-Based Indoor Localization under Shadowing Condition for P-NOMA VLC Systems

The localization of agents for collaborative tasks is crucial to maintain the quality of the communication link for successful data transmission between the base station and agents. Power-domain Non-Orthogonal Multiple Access (P-NOMA) is an emerging multiplexing technique that enables the base station to accumulate signals for different agents using the same time-frequency channel. The environment information such as distance from the base station is required at the base station to calculate communication channel gains and allocate suitable signal power to each agent. The accurate estimate of the position for power allocation of P-NOMA in a dynamic environment is challenging due to the changing location of the end-agent and shadowing. In this paper, we take advantage of the two-way Visible Light Communication (VLC) link to (1) estimate the position of the end-agent in a real-time indoor environment based on the signal power received at the base station using machine learning algorithms and (2) allocate resources using the Simplified Gain Ratio Power Allocation (S-GRPA) scheme with the look-up table method. In addition, we use the Euclidean Distance Matrix (EDM) to estimate the location of the end-agent whose signal was lost due to shadowing. The simulation results show that the machine learning algorithm is able to provide an accuracy of 0.19 m and allocate power to the agent.

Implementation of interprofessional learning in hospital practice

AIM

Some universities of applied science struggle with implementing interprofessional learning due to a lack of diversity in professions. The aim of this study was to investigate whether an interprofessional learning model with an informational letter describing interprofessional learning opportunities can provide nursing students in rural areas with sufficient interprofessional learning during internships.

DESIGN

This qualitative study utilized a hermeneutical approach.

METHODS

A total of 17 individuals participated in focus groups, group interviews and written responses. The data collection: January 2019.

RESULTS

Four categories were observed: (a) assumptions about interprofessional learning, (b) available interprofessional learning opportunities, (c) hindrances to interprofessional learning and (d) stimulation of interprofessional learning. The conclusion was that interprofessional learning can be implemented to some extent in areas where different professions work, even when only one student is present. A focus on interprofessional collaboration, patient safety and patient flow are valuable interprofessional learning objectives. An informational letter with suggestions for interprofessional learning, such as shadowing, was considered valuable by the participants.

Never too early: the impact of a shadowing programme in paediatric and congenital cardiac surgery for undergraduate college students

PURPOSE

Diversification of the medical and cardiothoracic surgical workforce represents an ongoing need. A congenital cardiac surgery shadowing programme for undergraduate students was implemented at the University of Florida Congenital Heart Center.

METHODS

Students shadowing in the Congenital Heart Center from 17 December 2020 through 20 July 2021 were sent a survey through Qualtrics to evaluate the impact of their shadowing experience. The main objectives of the survey were to determine the personal relationship(s) of the students to physicians prior to shadowing, how the presence or absence of physicians in the family of a given student related to the exposure of the student to a medical setting prior to shadowing, and the interest of the students in medicine and cardiothoracic surgery prior to and after the shadowing experience. Survey responses included "Yes/No" questions, scaled responses using a Likert scale, selection lists, and free text responses. When applicable, t-tests were utilised to assess differences between student groups.

RESULTS

Of the 37 students who shadowed during the study period, 26 (70%) responded. Most students were female (58%, n = 15), and the mean age was 20.9 ± 2.4 years. Students spent a mean duration of 95 ± 138 hours shadowing providers as part of the shadowing programme. Likert scale ratings of interest in the professions of medicine, surgery, and cardiothoracic surgery all increased after the shadowing experience (p < 0.01). Students with a family member in medicine had more clinical exposure prior to the shadowing programme (p < 0.01).

CONCLUSION

A surgical shadowing programme at a Congenital Heart Center may have an important formative impact on the views of undergraduate students regarding potential careers in surgery and medicine. Additionally, students without family members in medicine tend to have less prior exposure to medicine and could likely benefit more from this type of shadowing programme.

Observing a dynamical skeleton of turbulence in Taylor-Couette flow experiments

Recent work shows that recurrent solutions of the equations governing fluid flow play an important role in structuring the dynamics of turbulence. Here, an improved version of an earlier method (Krygier et al. 2021 J. Fluid. Mech. 923, A7 and Crowley et al. 2022 Proc. Natl Acad. Sci. USA 119, e2120665119) is used for detecting and analyzing intervals of time when turbulence 'shadows' (spatially and temporally mimics) recurrent solutions in both numerical simulations and laboratory experiments. We find that all the recurrent solutions shadowed in numerics are also shadowed in experiment, and the corresponding statistics of shadowing agree. Our results set the stage for experimentally grounded dynamical descriptions of turbulence in a variety of wall-bounded shear flows, enabling applications to forecasting and control. This article is part of the theme issue 'Taylor-Couette and related flows on the centennial of Taylor's seminal Philosophical Transactions paper (part 1)'.

A Nurse/Intern Partnership Program Accelerates Positive Relationship Formation Between Pediatric Interns and Pediatric Nurses

BACKGROUND

The relationship between nurses and interns affects the quality of patient care; efforts to improve this relationship are necessary for optimal care. Previously, relationship formation was found to depend on mutual trust, respect, effective communication, and undergoing the process of role formation, all of which require time. This led to the hypothesis that instituting a Nurse/Intern Partnership Program (NIPP) would accelerate relationship formation.

METHODS

Using a semi-structured interview guide, prior to NIPP implementation, one nurse (n = 5) and 2 second-year resident (total n = 6) focus groups were held. After implementation, one nurse (n = 6) and one intern (n = 9) focus group were held. The focus group data were analyzed using the 5 stages of qualitative research framework.

RESULTS

Thematic data analysis with 3 independent coders supported the previously developed model of relationship formation; the NIPP accelerated relationship formation between nurses and interns through creating an early ally, improving communication, and increasing role understanding. The program may have improved the culture of the pediatric unit. The interns reported more of a positive impact of the NIPP on nurse/intern relationship than the nurses.

CONCLUSIONS

The NIPP was positively received by pediatric residents and nurses and successfully accelerated relationship formation between the 2 groups.

Shadowing Behavior May Be Associated with an Inability to Recognize the External World: A Case Report of Shadowing in a Patient with Posterior Cortical Atrophy

Although shadowing behavior- when one individual closely follows another- is routinely documented among patients with dementia, its mechanisms have yet to be elucidated. In particular, there have been no detailed descriptions of patients with shadowing behavior. To propose its potential backgrounds, we describe a patient with posterior cortical atrophy who exhibited prominent shadowing behavior. He also experienced severe difficulties recognizing external stimuli, including visuospatial dysfunction, several types of agnosia, difficulties in verbal comprehension, disorientation, and its associated depression. This shadowing behavior may be adaptive relative to his extreme difficulty with recognizing the world around him.

Statistical Characterization of Wireless Power Transfer via Unmodulated Emission

In the past few years, the ability to transfer power wirelessly has experienced growing interest from the research community. Because the wireless channel is subject to a large number of random phenomena, a crucial aspect is the statistical characterization of the energy that can be harvested by a given device. For this characterization to be reliable, a powerful model of the propagation channel is necessary. The recently proposed generalized-K model has proven to be very useful, as it encompasses the effects of path loss, shadowing, and fast fading for a broad set of wireless scenarios, and because it is analytically tractable. Accordingly, the purpose of this paper is to characterize, from a statistical point of view, the energy harvested by a static device from an unmodulated carrier signal generated by a dedicated source, assuming that the wireless channel obeys the generalized-K propagation model. Specifically, by using simulation-validated analytical methods, this paper provides exact closed-form expressions for the average and variance of the energy harvested over an arbitrary time period. The derived formulation can be used to determine a power transfer plan that allows multiple or even massive numbers of low-power devices to operate continuously, as expected from future network scenarios such as the Internet of things or 5G/6G.

Theory of MBE Growth of Nanowires on Reflecting Substrates

Selective area growth (SAG) of III-V nanowires (NWs) by molecular beam epitaxy (MBE) and related epitaxy techniques offer several advantages over growth on unpatterned substrates. Here, an analytic model for the total flux of group III atoms impinging NWs is presented, which accounts for specular re-emission from the mask surface and the shadowing effect in the absence of surface diffusion from the substrate. An expression is given for the shadowing length of NWs corresponding to the full shadowing of the mask. Axial and radial NW growths are considered in different stages, including the stage of purely axial growth, intermediate stage with radial growth, and asymptotic stage, where the NWs receive the maximum flux determined by the array pitch. The model provides good fits with the data obtained for different vapor-liquid-solid and catalyst-free III-V NWs.

Unmanned Aerial Vehicle Propagation Channel over Vegetation and Lake Areas: First- and Second-Order Statistical Analysis

The use of unmanned aerial vehicles (UAV) to provide services such as the Internet, goods delivery, and air taxis has become a reality in recent years. The use of these aircraft requires a secure communication between the control station and the UAV, which demands the characterization of the communication channel. This paper aims to present a measurement setup using an unmanned aircraft to acquire data for the characterization of the radio frequency channel in a propagation environment with particular vegetation (Caatinga) and a lake. This paper presents the following contributions: identification of the communication channel model that best describes the characteristics of communication; characterization of the effects of large-scale fading, such as path loss and log-normal shadowing; characterization of small-scale fading (multipath and Doppler); and estimation of the aircraft speed from the identified Doppler frequency.

Discovering presence as part of nurse educators' role modelling at a public nursing college in the North West province

Background

Nursing students learn the science and art of nursing, including presence, from classroom content, using skills in practice, or by watching an experienced nurse interact with a patient. Nursing education must be designed so that nursing students can construct the art and science of nursing practice. Nursing students must be educated to be sound practitioners in the 'being' of nursing practice. Nurse educators modelling presence to nursing students will improve the quality of patient care during clinical training and throughout their professional role.

Aim

To explore and describe nurse educators' role modelling of presence to nursing students.

Setting

This study was conducted at a public nursing college in the North West province.

Methods

A qualitative, ethnographic study was conducted. Purposive sampling was used. Four nurse educators participated in the study and data saturation was reached. Data were collected through shadowing and informal reflective conversations over a period of 8 days.

Results

The following relationships emerged: nurse educators model 'being professional', 'being facilitating, nurturing, caring and compassionate, encouraging, and motivating', and 'being purposeful in their nursing education approach'.

Conclusion

Participants role modelled presence to nursing students despite daily challenges in their work.

Contribution

Creating awareness of how nurse educators can model presence despite daily challenges in their work will influence and motivate nursing students to develop presence skills. This will have a positive impact on managing patients in practice. Recommendations can guide nursing education, policy development and future research to strengthen nurse educators modelling presence.

Testing a 5G Communication System: Kriging-Aided O2I Path Loss Modeling Based on 3.5 GHz Measurement Analysis

Deep knowledge of how radio waves behave in a practical wireless channel is required for the effective planning and deployment of radio access networks in outdoor-to-indoor (O2I) environments. Using more than 400 non-line-of-sight (NLOS) radio measurements at 3.5 GHz, this study analyzes and validates a novel O2I measurement-based path loss prediction narrowband model that characterizes and estimates shadowing through Kriging techniques. The prediction results of the developed model are compared with those of the most traditional assumption of slow fading as a random variable: COST231, WINNER+, ITU-R, 3GPP urban microcell O2I models and field measured data. The results showed and guaranteed that the predicted path loss accuracy, expressed in terms of the mean error, standard deviation and root mean square error (RMSE) was significantly better with the proposed model; it considerably decreased the average error for both scenarios under evaluation.

The Reliability of Individual Differences in VOT Imitation

Recent work has shown that individuals vary in phonetic behaviors in ways that deviate from group norms and are not attributable to sociolinguistically relevant dimensions such as gender or social class. However, it is unknown whether these individual differences observed in the lab are stable characteristics of individuals or whether they simply reflect noise or sporadic fluctuations. This study investigates the individual-level stability in imitation of a model talker's artificially-lengthened VOT. We use a test-retest design in which the same set of participants perform the same lexical shadowing task on two separate occasions and find that degree of convergence or divergence is highly correlated on an individual basis across visits. Further, we find a strong correlation between individual VOT shifts toward a male model talker and shifts toward a female model talker. Findings contribute to a growing body of literature suggesting that averaging over groups of participants masks the complexity of phonetic behaviors, such as imitation, and suggest that individual differences in phonetic behavior are an area of promising future study.

Examining career shadowing in genetic counseling: Perspectives of shadowees, program directors, and genetic counselors

Career shadowing can be a valuable opportunity for individuals to experience the daily activities of a working professional. However, there is no published research regarding the impact of shadowing for individuals hoping to pursue a career as a genetic counselor (GC) (termed 'shadowees'). Additionally, little is known about the impact of shadowing on practicing GCs, nor the value of shadowing in the application and admission process for genetic counseling graduate programs. For this study, three independent surveys were developed and sent to three stakeholder groups: shadowees in the Minnesota Genetic Counseling Experience Program, program directors within the Association of Genetic Counseling Program Directors, and members of the National Society of Genetic Counselors. Quantitative and qualitative analyses were performed on responses. The survey of shadowees (n = 55) found that the majority believed that shadowing had either a 'very' or 'somewhat positive' impact on their decision to become a GC and on their application to a genetic counseling graduate program (81.8% and 91.3%, respectively). Of the participating program director respondents (n = 43), the majority indicated that having shadowing experience was either 'moderately' or 'extremely important' in offering an interview or for acceptance into a graduate program (63% and 56%, respectively). While programs differ in evaluation of shadowing experiences, most program directors indicated that an applicant's ability to speak to their shadowing experience was the most important factor in admissions consideration (71%). Among the GCs surveyed (n = 325), 69.2% have hosted shadowees; of these, 82.7% indicated that hosting a shadowee decreases their efficiency at work. Despite this drawback, the majority of respondents expressed a willingness and motivation to host shadowees to help the shadowee (64.8%) and to promote the genetic counseling profession (32.6%). These findings suggest the need for additional research and the development of resources for GCs to increase access of career shadowing.

Ultraviolet-C as a Viable Reprocessing Method for Disposable Masks and Filtering Facepiece Respirators

In normal conditions, discarding single-use personal protective equipment after use is the rule for its users due to the possibility of being infected, particularly for masks and filtering facepiece respirators. When the demand for these protective tools is not satisfied by the companies supplying them, a scenario of shortages occurs, and new strategies must arise. One possible approach regards the disinfection of these pieces of equipment, but there are multiple methods. Analyzing these methods, Ultraviolet-C (UV-C) becomes an exciting option, given its germicidal capability. This paper aims to describe the state-of-the-art for UV-C sterilization in masks and filtering facepiece respirators. To achieve this goal, we adopted a systematic literature review in multiple databases added to a snowball method to make our sample as robust as possible and encompass a more significant number of studies. We found that UV-C's germicidal capability is just as good as other sterilization methods. Combining this characteristic with other advantages makes UV-C sterilization desirable compared to other methods, despite its possible disadvantages.

Exploring second professional year pharmacy student reflections after an interprofessional shadowing experience with nursing students in critical care units: a qualitative study

Accreditation standards for pharmacy and nursing education require interprofessional education (IPE) as a key component in both curricula. There is increasing evidence for using interprofessional shadowing as a learning modality for IPE; reflection can be used to enhance learning from these experiences. We explored pharmacy student-reported reflections from an interprofessional shadowing experience with nursing students through qualitative content analysis of reflective statements. We found that pharmacy students gained knowledge of nursing roles and areas of expertise, awareness of how the team provides care, and awareness of the importance of communication and mutual respect to improve both team performance and patient safety. Additionally, we were able to assess interprofessional sub-competencies that were met as a result of the interprofessional shadowing experience, specifically, pharmacy students gained knowledge and skills across all four IPEC Core Competencies. Interprofessional shadowing combined with reflection can enhance learning, and thematic analysis of these reflections can be utilized to assess IPE outcomes.

Path Loss Prediction based on Machine Learning Techniques: Principal Component Analysis, Artificial Neural Network and Gaussian Process

Although various linear log-distance path loss models have been developed for wireless sensor networks, advanced models are required to more accurately and flexibly represent the path loss for complex environments. This paper proposes a machine learning framework for modeling path loss using a combination of three key techniques: artificial neural network (ANN)-based multi-dimensional regression, Gaussian process-based variance analysis, and principle component analysis (PCA)-aided feature selection. In general, the measured path loss dataset comprises multiple features such as distance, antenna height, etc. First, PCA is adopted to reduce the number of features of the dataset and simplify the learning model accordingly. ANN then learns the path loss structure from the dataset with reduced dimension, and Gaussian process learns the shadowing effect. Path loss data measured in a suburban area in Korea are employed. We observe that the proposed combined path loss and shadowing model is more accurate and flexible compared to the conventional linear path loss plus log-normal shadowing model.

Interprofessional identity development within a brief shadowing experience: An exploratory case study

The Deans' Interprofessional Honors Colloquium (DIHC) is an honors-level interprofessional elective course that provides a seminar-based forum for students from eleven academic programs to explore the characteristics and implications of collaborative interprofessional practice around a contemporary health topic. This project-based course combines didactic presentations, interactive group learning, and an interprofessional shadowing experience with a corresponding written reflection paper. Ten semesters of Interprofessional Shadowing Reflections (n = 401) were studied via thematic and content analyses to examine the extent to which a brief interprofessional shadowing experience influenced interprofessional identity development. Interprofessional socialization framework was employed as a lens to refine themes and to track students' trajectory in developing a dual professional identity. This exploratory case study indicated that nearly all participants' reflections included content indicative of the second stage (interprofessional role learning) of the interprofessional socialization framework, and many progressed toward the third stage (dual identity development). Major themes included emergent role learning, increased differentiation among roles and care models, and increased appreciation for other professionals. The experience provided an opportunity for correction of misconceptions and improved understanding of the role and practice of other professions. Nearly all of the participating students (1) reflected on the benefits of interprofessional collaboration and (2) indicated a desire to work interprofessionally in the future, an early indication of dual identity formation. Findings indicated that the interprofessional shadowing experience and written reflection were highly valuable elements of the DIHC and provided a critical opportunity for interprofessional identity development.

Association of Shadowing Program for Undergraduate Premedical Students with Improvements in Understanding Medical Education and Training

OBJECTIVE

Physician shadowing has become ubiquitous to the premedical experience. However, students without connections to a medical professional are oftentimes forced to reach out to physicians independently from a program. Subsequently, these inquiries may go unanswered as they oftentimes appear unsolicited. The primary goals in the design and development of our program were to increase access to a clinical observership experience at our academic institution utilizing resident physicians as primary supervisors.

METHODS

In January 2017, the Educational Shadowing Program (ESP) was established at our institution wherein undergraduate students could shadow within the Pediatric Continuity Clinic (PCC) staffed by pediatric resident physicians. ESP undergraduates shadowed the residents as they performed their history taking and physical exams and as they presented their patients to the attending physicians. Between patient encounters, the students assisted the residents in their administrative work which was completed as needed. ESP students were surveyed at their first orientation meeting and during the final case conference.

RESULTS

The pre-participation survey showed that none of the student participants strongly agreed to having a good understanding of what the job of a resident physician entails. By the end of their 30 weeks, the proportion of participants with a strongly perceived understanding increased significantly. The proportion of student respondents that strongly agreed with their understanding of the physician-patient interaction also improved significantly over the study period, from 33% to 78%. Seventy-two percent of the residents surveyed agreed or strongly agreed that they enjoyed having the undergraduates in the clinic, affirming the positive effects of the program on the resident physicians. Forty-five percent of residents agreed or strongly agreed that the undergraduates improved their workflow in the clinic.

CONCLUSION

This study demonstrates that establishing an undergraduate shadowing program in a busy academic pediatric clinic that involves resident physicians can be an overall positive experience for all participants. Fostering premedical student interest in pediatric care and primary care can possibly lead to more physician commitment to these fields, potentially helping to alleviate impending physicians in these specialties.

Junior doctors' experience of interprofessional shadowing in a palliative care setting

Interprofessional shadowing, whereby medical students take on the role of another profession, is an effective interprofessional education (IPE) method to promote interprofessional teamwork. Palliative care is an ideal setting for IPE as multidisciplinary teams work together to deliver holistic patient care. This brief report explores junior doctors' experiences in shadowing nurses to provide care to patients in a hospice setting in New Zealand. We conducted semi-structured interviews with six participants to find out the impact that this shadowing experience had on their professional development and feasibility of incorporating this activity into the undergraduate medical curriculum. Inductive thematic analysis revealed that shadowing a nurse for two days increased participants' awareness of the nursing role and gave them the opportunity to develop a personal relationship with their patients, both of which made participants actively reflect on the value of IPE and the way they practice medicine. Participants considered the palliative care setting as conducive to IPE and saw the value of incorporating interprofessional shadowing into the undergraduate medical curriculum.

Impact of Preclinical Labor and Delivery Shadowing on Student Perceptions of Obstetrics and Gynecology as a Specialty and Possible Career: A Prospective Cohort

Objective  The purpose of this study was to determine the impact of preclinical shadowing on student interest and perceptions of obstetrics and gynecology (OBGYN). Methods  We enrolled a prospective cohort of preclinical medical students who shadowed on labor and delivery (L&D). Students sent electronic surveys a week prior (presurvey), the week after (postsurvey), and three months after shadowing (far-survey). Responses compared using descriptive statistics. We analyzed common themes of free text responses. Results  From July 2016 to April 2017, 41 students shadowed on L&D; 81% were female. Eighty percent responded to at least one survey, 37% completed all surveys, (presurvey: 76%, postsurvey: 51%, and far-survey: 46%). Prior to shadowing, 10% (3/31) planed a career in OBGYN compared with 24% (5/21) after shadowing ( p  = 0.42). Over 50% of students described the people and procedures as altering their perceptions of OBGYN in a positive way. Common themes explaining this change included: culture ( n  = 4), team interactions ( n  = 4), seeing deliveries ( n  = 3), and hands-on experiences ( n  = 3). Three months after shadowing, 79% described the experience as very worthwhile. Eighty-nine percent would recommend the experience to a friend not interested in OBGYN and 100% stated they would shadow again. Discussion  Although shadowing may not increase students' desire to pursue OBGYN, it is nearly universally felt to be worthwhile and improves perceptions of the field.

Bimodal Porosity and Stability of a TiO2 Gig-Lox Sponge Infiltrated with Methyl-Ammonium Lead Iodide Perovskite

We created a blend between a TiO2 sponge with bimodal porosity and a Methyl-Ammonium Lead Iodide (MAPbI3) perovskite. The interpenetration of the two materials is effective thanks to the peculiar sponge structure. During the early stages of the growth of the TiO2 sponge, the formation of 5-10 nm-large TiO2 auto-seeds is observed which set the micro-porosity (<5 nm) of the layer, maintained during further growth. In a second stage, the auto-seeds aggregate into hundreds-of-nm-large meso-structures by their mutual shadowing of the grazing Ti flux for local oxidation. This process generates meso-pores (10-100 nm) treading across the growing layer, as accessed by tomographic synchrotron radiation coherent X-ray imaging and environmental ellipsometric porosimetry. The distributions of pore size are extracted before (>47% V) and after MAPbI3 loading, and after blend ageing, unfolding a starting pore filling above 80% in volume. The degradation of the perovskite in the blend follows a standard path towards PbI2 accompanied by the concomitant release of volatile species, with an activation energy of 0.87 eV under humid air. The use of dry nitrogen as environmental condition has a positive impact in increasing this energy by ~0.1 eV that extends the half-life of the material to 7 months under continuous operation at 60 °C.

Description and Assessment of a Neurosurgery Shadowing and Research Program: A Paradigm for Early and Sustained Exposure to Academic Neurosurgery

Objective

To describe and assess the educational value of a functional neurosurgery clinical shadowing and research tutorial for pre-medical trainees.

Design

Program participants observed functional neurosurgery procedures and conducted basic science and clinical research in neurosurgery fields. Former participants completed a brief online survey to evaluate their perspectives and experiences throughout the tutorial.

Setting

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Participants

15 pre-medical and post-baccalaureate trainees participated in the tutorial. All former tutorial participants were emailed.

Results

11/15 former participants responded to the survey. Survey results suggest that the tutorial program increased participants' understanding of and interest in neurosurgery and related fields in neuroscience.

Conclusions

The functional neurosurgery medical tutorial provides valuable clinical and research exposure in neurosurgery fields for pre-medical trainees. Our work is a preliminary step in addressing the crucial challenge of training the next generation of neurosurgeon-scientists by providing a pedagogical paradigm for development of formal experiences that integrate original scientific research with clinical neurosurgery exposure.

Impact of the Shadowing Effect on the Crystal Structure of Patterned Self-Catalyzed GaAs Nanowires

The growth of regular arrays of uniform III-V semiconductor nanowires is a crucial step on the route toward their application-relevant large-scale integration onto the Si platform. To this end, not only does optimal vertical yield, length, and diameter uniformity have to be engineered, but also, control over the nanowire crystal structure has to be achieved. Depending on the particular application, nanowire arrays with varying area density are required for optimal device efficiency. However, the nanowire area density substantially influences the nanowire growth and presents an additional challenge for nanowire device engineering. We report on the simultaneous in situ X-ray investigation of regular GaAs nanowire arrays with different area density during self-catalyzed vapor-liquid-solid growth on Si by molecular-beam epitaxy. Our results give novel insight into selective-area growth and demonstrate that shadowing of the Ga flux, occurring in dense nanowire arrays, has a crucial impact on the evolution of nanowire crystal structure. We observe that the onset of Ga flux shadowing, dependent on array pitch and nanowire length, is accompanied by an increase of the wurtzite formation rate. Our results moreover reveal the paramount role of the secondary reflected Ga flux for VLS NW growth (specifically, that flux that is reflected directly into the liquid Ga droplet).

Characterization of Path Loss and Large-Scale Fading for Rapid Intervention Team Communication in Underground Parking Garages

This paper reports the characterization of the 2.45-GHz-ISM-band radio wave propagation channel. Specifically, measurements were performed in an underground parking garage, with the aim of optimizing breadcrumb systems for a Rapid Intervention Team application. The effects of the high penetration loss and large reflections by the concrete reinforced building structure on the path loss and the large-scale fading were studied. Based on the analysis of the wireless channel, critical points for reliable communication between members of a Rapid Intervention Team were identified. In particular, attention was paid to dealing with large, spatially confined signal losses due to shadowing, the anticipation of corner losses and the ability of the system to operate on multiple floors.

Study of Shadowing Experiences among Chaplains in the Coleman Palliative Medicine Fellowship

While shadowing is a relatively common practice in the education of many health professionals, it is not widely used in chaplaincy education. Findings from our qualitative study of 12 chaplains who participated in the Coleman Palliative Medicine Training Program suggest it may offer benefits for practicing chaplains. In interviews with seven fellows who shadowed more experienced palliative care (PC) chaplains and the five mentors who were shadowed at their work settings, participants reported opportunities for mutual learning, self-reflection, and collegiality. Fellows observed how members of a PC team collaborate and contribute equally to the care of patients. Mentors found shadowing was a rare opportunity to share their chaplaincy practice with colleagues. It helped them to appreciate different aspects of their work settings and to distinguish between PC and generalist chaplaincy. We discuss the challenges participants experienced while shadowing and offer recommendations for incorporating the practice more widely into chaplaincy education.

Survey of Osteopathic Medical Students Regarding Physician Shadowing Experiences Before and During Medical School Training

INTRODUCTION

Shadowing a physician is an observational experience which includes a student observing a licensed healthcare provider caring for patients. Shadowing is commonly done by students before and during medical school, but little is known about the nature or extent of these extra-curricular observational experiences.

OBJECTIVE

We hypothesized that shadowing experiences were common yet variable. We investigated the prevalence, nature, and perceived value of medical student experiences with shadowing physicians (both before and during medical school).

METHODS

This survey-based study was non-experimental with a cross-sectional convenience sample of osteopathic medical students about their shadowing experiences before and during medical school. The survey was sent to all matriculated osteopathic medical students (OMS1-4) for the 2017 to 2018 academic year from two medical schools: Philadelphia College of Osteopathic Medicine (PCOM) (1084 total students) and PCOM-Georgia (554 total students). The final survey instrument included three sections: demographics (6 questions), pre-medical shadowing experiences (21 questions), and medical student shadowing experiences (24 questions).

RESULTS

Respondents (357) identified themselves as OMS1 (96), OMS2 (89), OMS3 (73), OMS4 (95) and other (2, OMS5) with enrollment at PCOM-Philadelphia (242) and PCOM-Georgia (115). Among survey respondents, 339 (95.5%) reported shadowing a physician as a pre-medical student, and 110 (30.8%) reported shadowing (outside of their required clinical rotations) a physician during medical school. Requirements to participate were inconsistent; fewer than 50% of shadowing experiences required Health Insurance Portability and Accountability Act of 1996 (HIPAA) training, proof of vaccination, or purified protein derivative (PPD) documentation. In addition to observation, pre-medical and medical students, respectively, participated in history taking (44 [13%], 47 [42.7%]), physical examinations (45 [13.3%], 44 [40%]) and procedures (13, [3.8%], 20 [18.2%]) during their shadowing experiences. Motivations to participate in shadowing varied between pre-medical and medical student experiences, but both groups mentioned their desire to learn more about a particular discipline, obtain letters of recommendation, and gain patient care experience. Students recommended both pre-medical (273 [80.5%]) and medical school (93 [84.5%]) shadowing to future students.

CONCLUSION

Shadowing remains a common and important tool for students to learn about patient care, medicine and careers. The nature of each shadowing experience and participation requirements are quite variable. Measures to ensure patient safety, confidentiality, liability and supervision are inconsistently applied. Promoting guidelines, as well as codes of conduct, for shadowing could serve as a helpful resource for students, academic advisors and supervising clinicians.

Plasma Galectin-3 and Sonographic Measures of Carotid Atherosclerosis in the Atherosclerosis Risk in Communities Study

Galectin-3 is a β-galactoside-binding lectin that plays a role in the regulation of several conditions that are associated with atherosclerosis. The goal of this cross-sectional study was to assess the association of plasma galectin-3 concentrations with sonographic measures of carotid atherosclerosis in the Atherosclerosis Risk in Communities study. Linear regression was used to determine the difference and 95% confidence intervals (CIs) for carotid intima-media thickness (cIMT) by categorical and continuous representations of galectin-3. Logistic regression was used to determine the odds ratio and 95% CI, separately, for dichotomized cIMT (75th percentile = 0.9 mm) and carotid plaque and/or shadowing. Compared to those in the first quintile of galectin-3, those in the fifth quintile of galectin-3 level had higher cIMT (mean difference: 0.020 mm after multivariable adjustment; P trend = .04). Moreover, compared to those in the lowest galectin-3 quintile, those in the highest galectin-3 quintile had higher odds of carotid plaque/and or shadowing (odds ratio 1.13 after multivariable adjustment; P trend = .014). Higher levels of galectin-3 are associated with greater carotid atherosclerosis. Our findings provide support for the role of inflammatory biomarkers in the pathogenesis of atherosclerosis and suggest galectin-3 as a possible target for intervention in the prevention or management of atherosclerotic disease.

Improving role identity by shadowing interprofessional team members in a clinical setting: an innovative clinical education course

Incorporating Interprofessional Education (IPE) into the training of health care professionals has become an important component of nursing education. Students are expected to graduate with skills necessary for integrated care delivery to improve quality and safety. In an effort to formally expose nursing students to the roles and responsibilities of members of the health care team, a clinical course was developed within a school of nursing which included a significant interprofessional shadowing component. The course includes a total of 168 clinical hours. Shadowing makes up one third or approximately 56 of the total clinical hours. The students completed a critical reflection to evaluate the effectiveness of the shadowing experience and to determine if course objectives were met. The reflective activity allowed students to describe their observations, discuss new insights into the role of the discipline and express thoughts and feelings as they observe the daily work of the health care team. This qualitative study analyzed these critical reflections from a course in which students were enrolled between 2013 and 2015. Researchers selected a purposive sample of 50 reflections out of more than 200 submissions. Four major themes were identified: communication between health care providers necessary for achieving quality patient outcomes; new perspectives on role identity; learning from other professions; and increased confidence in collaborating with other members of the team. This new clinical education course, with an IPE shadowing component, improved insight and confidence in collaborating with members of the interprofessional team. The course provided students with the opportunity to strengthen role identity, observe communication between disciplines in the clinical setting, and acquire skills that will facilitate the new graduate's ability to work effectively with members of the health care team.

Clinical Neuroscience in Practice: An Experiential Learning Course for Undergraduates Offered by Neurosurgeons and Neuroscientists

Many pre-health students pursue extracurricular shadowing opportunities to gain clinical experience. The Virginia Tech School of Neuroscience introduced a formal course that provides a clinical experience superior to that received by many medical students. This course is composed of weekly 75-minute seminars that cover diseases affecting the nervous system, their diagnosis and treatment, complemented by weekly half-day intensive clinical experiences with unprecedented access to a team of neurosurgeons (in hospital operating rooms, Intensive Care Units, emergency room, angiographic suites, and wards). In the operating rooms, students routinely "scrub-in" for complex surgeries. On hospital rounds, students experience direct patient care and receive in-depth exposure to modern nervous system imaging. Students participate in two 24-hour "on-call" experiences with team providers. After call, students participate in cognitive and psychological studies to assess physiological and psychological effects of call-related sleep deprivation. Students prepare weekly essays on challenging socioeconomic and ethical questions, exploring subjects such as the cost of medicine and inequalities in access to health care. Towards the end of the course, students meet with the admission dean of the Virginia Tech Carilion medical school; they prepare a personal statement for medical school/graduate school applications, and attend a half-day block of mock medical school/graduate school interviews delivered by experienced clinicians. In lieu of a final exam, each student presents to the entire neurosurgery department, an in-depth clinical analysis of a case in which they participated. We provide details on implementation, challenges and outcomes based on experiences from three semesters with a total enrollment of approximately 60 students.

Does the Consecutive Interpreting Approach enhance medical English communication skills of Japanese-speaking students?

OBJECTIVES

To determine if the Consecutive Interpreting Approach enhances medical English communication skills of students in a Japanese medical university and to assess this method based on performance and student evaluations.

METHODS

 This is a three-phase study using a mixed-methods design, which starts with four language reproduction activities for 30 medical and 95 nursing students, followed by a quantitative analysis of perfect-match reproduction rates to assess changes over the duration of the study and qualitative error analysis of participants' language reproduction. The final stage included a scored course evaluation and free-form comments to evaluate this approach and to identify effective educational strategies to enhance medical English communication skills.

RESULTS

Mean perfect-match reproduction rates of all participants over four reproduction activities differed statistically significantly (repeated measures ANOVA, p<0.0005). The overall perfect-match reproduction rates improved from 75.3 % to 90.1 % for nursing and 89.5 % to 91.6% for medical students. The final achievement levels of nursing and medical students were equivalent (test of equivalence, p<0.05). Details of lexical- and syntactic-level errors were identified. The course evaluation scores were 3.74 (n=30, SD = 0.59) and 3.77 (n=90, SD=0.54) for medical and nursing students respectively.

CONCLUSIONS

Participants' medical English communication skills are enhanced using this approach. Participants expressed positive feedback regarding this instruction method. This approach may be effective to enhance the language skills of non-native English-speaking students seeking to practice medicine in English speaking countries.

Comparative study of sculptured metallic thin films deposited by oblique angle deposition at different temperatures

Metals with a wide range of melting points are deposited by electron beam evaporation under oblique deposition geometry on thermally oxidized Si substrates. During deposition the sample holder is cooled down to 77 K. It is observed that all obliquely deposited metals grow as tilted, high aspect ratio columns and hence with a similar morphology. A comparison of such columns with those deposited at room temperature (300 K) reveals that shadowing dominates the growth process for columns deposited at 77 K, while the impact of surface diffusion is significantly increased at elevated substrate temperatures. Furthermore, it is discussed how the incidence angle of the incoming particle flux and the substrate temperature affect the columnar tilt angles and the porosity of the sculptured thin films. Exemplarily for tilted Al columns deposited at 77 K and at 300 K, in-plane pole figure measurements are carried out. A tendency to form a biaxial texture as well as a change in the crystalline structure depending on the substrate temperature is found for those films.

Measuring and Modeling the Growth Dynamics of Self-Catalyzed GaP Nanowire Arrays

The bottom-up fabrication of regular nanowire (NW) arrays on a masked substrate is technologically relevant, but the growth dynamic is rather complex due to the superposition of severe shadowing effects that vary with array pitch, NW diameter, NW height, and growth duration. By inserting GaAsP marker layers at a regular time interval during the growth of a self-catalyzed GaP NW array, we are able to retrieve precisely the time evolution of the diameter and height of a single NW. We then propose a simple numerical scheme which fully computes shadowing effects at play in infinite arrays of NWs. By confronting the simulated and experimental results, we infer that re-emission of Ga from the mask is necessary to sustain the NW growth while Ga migration on the mask must be negligible. When compared to random cosine or random uniform re-emission from the mask, the simple case of specular reflection on the mask gives the most accurate account of the Ga balance during the growth.

Estimating the Illumination Direction From Three-Dimensional Texture of Brownian Surfaces

We studied whether human observers can estimate the illumination direction from 3D textures of random Brownian surfaces, containing undulations over a range of scales. The locally Lambertian surfaces were illuminated with a collimated beam from random directions. The surfaces had a uniform albedo and thus texture appeared only through shading and shadowing. The data confirm earlier results with Gaussian surfaces, containing undulations of a single scale. Observers were able to accurately estimate the source azimuth. If shading dominated the images, the observers committed 180° errors. If cast shadows were present, they resolved this convex-concave-ambiguity almost completely. Thus, observers relied on second-order statistics in the shading regime and used an unidentified first-order cue in the shadow regime. The source elevations could also be estimated, which can be explained by the observers' exploitation of the statistical homogeneity of the stimulus set. The fraction of the surface that is in shadow and the median intensity are likely cues for these elevation estimates.

Determining the True Cost to Deliver Total Hip and Knee Arthroplasty Over the Full Cycle of Care: Preparing for Bundling and Reference-Based Pricing

The Affordable Care Act accelerates health care providers' need to prepare for new care delivery platforms and payment models such as bundling and reference-based pricing (RBP). Thriving in this environment will be difficult without knowing the true cost of care delivery at the level of the clinical condition over the full cycle of care. We describe a project in which we identified true costs for both total hip and total knee arthroplasty. With the same tool, we identified cost drivers in each segment of care delivery and collected patient experience information. Combining cost and experience information with outcomes data we already collect allows us to drive costs down while protecting outcomes and experiences, and compete successfully in bundling and RBP programs.

Naming in noise: the contribution of orthographic knowledge to speech repetition

While the influence of orthographic knowledge on lexical and postlexical speech processing tasks has been consistently observed, it is not the case in tasks that can be performed at the prelexical level. The present study re-examined the orthographic consistency effect in such a task, namely in shadowing. Comparing the situation where the acoustic signal was clearly presented to the situation where it was embedded in noise, we observed that the orthographic effect was restricted to the latter situation and only to high-frequency words. This finding supports the lexical account of the orthographic effects in speech recognition tasks and illustrates the ability of the cognitive system to adjust itself as a function of task difficulty by resorting to the appropriate processing mechanism and information in order to maintain a good level of performance.

Naming in noise: the contribution of orthographic knowledge to speech repetition

While the influence of orthographic knowledge on lexical and postlexical speech processing tasks has been consistently observed, it is not the case in tasks that can be performed at the prelexical level. The present study re-examined the orthographic consistency effect in such a task, namely in shadowing. Comparing the situation where the acoustic signal was clearly presented to the situation where it was embedded in noise, we observed that the orthographic effect was restricted to the latter situation and only to high-frequency words. This finding supports the lexical account of the orthographic effects in speech recognition tasks and illustrates the ability of the cognitive system to adjust itself as a function of task difficulty by resorting to the appropriate processing mechanism and information in order to maintain a good level of performance.

Naming in noise: the contribution of orthographic knowledge to speech repetition

While the influence of orthographic knowledge on lexical and postlexical speech processing tasks has been consistently observed, it is not the case in tasks that can be performed at the prelexical level. The present study re-examined the orthographic consistency effect in such a task, namely in shadowing. Comparing the situation where the acoustic signal was clearly presented to the situation where it was embedded in noise, we observed that the orthographic effect was restricted to the latter situation and only to high-frequency words. This finding supports the lexical account of the orthographic effects in speech recognition tasks and illustrates the ability of the cognitive system to adjust itself as a function of task difficulty by resorting to the appropriate processing mechanism and information in order to maintain a good level of performance.