BACKGROUND:Physical Examination (PE) skills are vital for patient care, and many medical students receive their first introduction to them in their pre-clinical years. A substantial amount of curriculum time is devoted to teaching these skills in most schools. Little is known about the best way to introduce PE skills to novice learners. OBJECTIVE:Our objective was to conduct a systematic review of how medical students are first taught PE skills and the evidence supporting these strategies. DESIGN:We searched ERIC, SCOPUS, MEDLINE, PubMed and EMBASE for descriptions of complete PE curricula for novice learners. Inclusion criteria were: (1) English language; (2) subjects were enrolled in medical school and were in the preclinical portion of their training; (3) description of a method to teach physical examination skills for the first time; (4) description of the study population; (5) Description of a complete PE curriculum. We used the Medical Education Research Study Quality Instrument (MERSQI) score to evaluate the quality of evidence provided. RESULTS:Our search returned 5,418 articles; 32 articles met our inclusion criteria. Two main types of curricula were reported: comprehensive 'head-to-toe' PE curricula (18%) and organ system-based curricula (41%). No studies compared these directly, and only two evaluated trainees' clinical performance. The rest of the articles described interventions used across curricula (41%). Median MERSQI score was 10.1 Interquartile range 8.1-12.4. We found evidence for the use of non-faculty teaching associates, technology-enhanced PE education, and the addition of clinical exposure to formal PE teaching. CONCLUSIONS:The current literature on teaching PE is focused on describing innovations to head-to-toe and organ system-based curricula rather than their relative effectiveness, and is further limited by its reliance on short-term outcomes. The optimal strategy for novice PE instruction remains unknown.
© 2019 Elsevier Inc. In many literatures, scholars study summarized attribute preferences: overall evaluative summaries of an attribute (e.g., a person's liking for the attribute “attractive” in a mate). But we know little about how people form these ideas about their likes and dislikes in the first place, in part because of a dearth of paradigms that enable researchers to experimentally change people's attribute preferences. Drawing on theory and methods in covariation detection and social cognition, we developed a paradigm that examines how people infer summarized preferences for novel attributes from functional attribute preferences: the extent to which the attribute predicts an individual's evaluations across multiple targets (e.g., a person's tendency to positively evaluate mates who are more vs. less attractive). In three studies, participants encountered manipulated information about their own functional preference for a novel attribute in a set of targets. They then inferred a summarized preference for the attribute. Summarized preferences corresponded strongly to the functional preference manipulation when targets varied on only one attribute. But additional complexity (in the form of a second novel attribute) caused summarized and functional preferences to diverge, and biases emerged: Participants reported stronger summarized preferences for the attribute when the population of targets possessed more of the attribute on average (regardless of functional preference strength). We also documented some support for a standard-of-comparison mechanism to explain this inferential bias. These studies elucidate factors that may warp the translation process from people's experienced evaluative responses in the world to their overall, summary judgments about their attribute preferences.
© 2018 American Chemical Society. This work presents the first direct evidence of multivalent binding between bone morphogenetic protein-2 (BMP-2) and cartilage oligomeric matrix protein (COMP) using high-resolution atomic force microscopy (AFM) imaging. AFM topographic images reveal the molecular morphology of COMP, a pentameric protein whose five identical monomer units bundle together at N-termini, extending out with flexible chains to C-termini. Upon addition of BMP-2, COMP molecules undergo conformational changes at the C-termini to enable binding with BMP-2 molecules. AFM enables local structural changes of COMP to be revealed upon binding various numbers, 1-5, of BMP-2 molecules. These BMP-2/COMP complexes exhibit very different morphologies from those of COMP: much more compact and thus less flexible. These molecular-level insights deepen current understanding of the mechanism of how the BMP-2/COMP complex enhances osteogenesis among osteoprogenitor cells, i.e., multivalent presentation of BMP-2 via the stable and relatively rigid BMP-2/COMP complex could form a lattice of interaction between multiple BMP-2 and BMP-2 receptors. These ligand-receptor clusters lead to fast initiation and sustained activation of the Smad signaling pathway, resulting in enhanced osteogenesis. This work is also of translational importance as the outcome may enable use of lower BMP-2 dosage for bone repair and regeneration.
© 2019 Wiley Periodicals, Inc. Color depth is difficult to evaluate; however, it plays an important role in the assessments of color fastness, dyeing properties, and so on. The subjective evaluation of color depth is prone to be affected by people, environment, etc. As for objective evaluation, there are more than 10 formulas, which confuses the user. In this study, a theoretically designed new formula is inspected through 18195 chips with 24 grades of color depth from the SINO COLOR BOOK, with the help of four preferable objective evaluation formulas. The specimens were measured using an X-Rite Color i7 spectrophotometer, and all their depth values were calculated and statistically analyzed by programming MATLAB. Of the five formulas, the new formula yields the best outcome of variance coefficients (CVs) but the worst linearity, with a correlation coefficient R = 0.976. It was then theoretically revised to two other formulas, one obtains the highest linearity (R = 0.9997) and the third CV, and the other gains the second linearity (R = 0.9984) and the second CV among the seven formulas. Besides, the three new formulas are not as sensitive as the others to the changes of Hue and Chroma. In general, the new revised formulas show potential and need to be further evaluated.
© 2019 Elsevier Ltd Toxic chemicals within and adsorbed to microplastics (0.05–5 mm) have the potential to biomagnify in food webs. However, microplastic concentrations in highly productive, coastal habitats are not well understood. Therefore, we quantified the presence of microplastics in a benthic community and surrounding environment of a remote marine reserve on the open coast of California, USA. Concentrations of microplastic particles in seawater were 36.59 plastics/L and in sediments were 0.227 ± 0.135 plastics/g. Densities of microplastics on the surfaces of two morphologically distinct species of macroalgae were 2.34 ± 2.19 plastics/g (Pelvetiopsis limitata) and 8.65 ± 6.44 plastics/g (Endocladia muricata). Densities were highest in the herbivorous snail, Tegula funebralis, at 9.91 ± 6.31 plastics/g, potentially due to bioaccumulation. This study highlights the need for further investigations of the prevalence and potential harm of microplastics in benthic communities at remote locations as well as human population centers.
© 2019, Springer Nature B.V. Innovative telemetry and biologging technology has increased the amount of available movement data on aquatic species. However, real-time information on the environmental factors influencing animal movements can be logistically challenging to obtain, particularly in habitats where tides and currents vary locally. Hydrodynamic models are capable of simulating complex tidal flow, and may thus offer an alternative method of contextualizing animal movement in coastal habitats. Here we use this tool to examine the influence of tide on the movement of broadnose sevengill sharks (Notorynchus cepedianus) in the San Francisco Bay estuary. Three sharks were actively tracked using acoustic transmitters for 3 to 4 days. We then generated a hydrodynamic model of the estuary and calculated current vectors along each track. We hypothesized that the sharks would adjust their swimming speed and direction depending on current strength when passing through the channel underneath the Golden Gate Bridge. Our results indicate that sharks did tend to follow the current flow in the channel, but their overall displacement did not significantly correlate with tidal amplitude. We conclude that the sharks may respond to environmental factors other than tidal flow, altering their movement at a finer scale than initially considered. Overall, this suggests that hydrodynamic simulation models can be used to visualize and quantify environmental factors that may affect movement patterns in aquatic organisms. We recommend future studies combine these models with other biologging techniques to measure energy expenditure at a finer spatial scale.
