Nonacademic Settings Research Articles

‘Retroactive effects’: Ratzel's spatial dynamics and the expansionist imperative in interwar Germany

This intervention examines the effects of spatial distribution on animal and human life forms as depicted in Ratzel’s Der Lebensraum, and interrogates the reception of Ratzel’s understanding of spatial dynamics in Germany between 1919 and 1939. Primary attention is given not to the often-studied reception of Ratzel by the German Geopolitiker, but to the impact of Ratzel’s emphasis on large spaces in non-academic settings – Herman Sörgel’s visions of Atlantropa, Colin Ross’s aesthetic theorizing, Arthur Dix’s colonialist nostalgia – and in particular to the relationship between Lebensraum and the rise of popular, pseudo-scientific demographic alarmism. The imprecise and often allusive nature of Ratzel’s depiction of the relationship between large spaces and biological well-being, it is argued, endowed his ideas with utility across the interwar German political spectrum.

Outcomes of a Series of 237 Patients with Early Stage Peripheral NSCLC, Treated by SABR in a Single Institution Non-academic Setting

Introduction: Stereotactic radiotherapy (SABR) is a treatment option for patients with early stage NSCLC who are medically inoperable or who decline surgery. A meta-analysis of 40 SABR studies (4850 patients) showed overall survival at 1, 3 and 5 years of 83.4%, 56.6% and 41.2%, respectively. Most of these data come from large academic centres.

MP84-04 PRACTICE PATTERNS AND ATTITUDES AMONG UROLOGISTS IN THE MANAGEMENT OF ACUTE ISCHEMIC PRIAPISM

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease II1 Apr 2018MP84-04 PRACTICE PATTERNS AND ATTITUDES AMONG UROLOGISTS IN THE MANAGEMENT OF ACUTE ISCHEMIC PRIAPISM Jessica Dai, Omer Raheem, and Thomas Walsh Jessica DaiJessica Dai More articles by this author , Omer RaheemOmer Raheem More articles by this author , and Thomas WalshThomas Walsh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2772AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite national guidelines on the management of priapism, there remains widespread variation in practice patterns. Moreover, in many areas, acute ischemic priapism is managed by Emergency Medicine providers. To date, the practice patterns and attitudes of urologists regarding the management of this entity are poorly characterized. METHODS From July to September 2017, urologists in both academic and community-based practices were asked to anonymously complete an online survey detailing their management practices for acute ischemic priapism and attitudes toward its management by trainees and non-urology providers. Survey participants included urology residents, fellows, and practicing urologists. Participants were contacted through the Society for the Study of Male Reproduction (SSMR), state urological societies, and direct solicitation. Responses from pediatric urologists were excluded. RESULTS 58 individuals responded to the survey and included 44 practicing urologists, 5 fellows, and 9 urology residents. Every American Urological Association (AUA) Section was represented, and 39.7% of respondents practiced in a non-academic setting. 50% recommend oral agents (terbutaline, pseudoephedrine, or others) in the treatment of acute ischemic priapism. After 24 hours of duration, 83% of respondents would begin treatment with corporal aspiration and/or irrigation, vs. 74% at 48 hours and 65% beyond 72 hours. At 24 hours, 3.4% would begin treatment with a distal shunt alone, vs. 8.5% at 48 hours and 13.8% after 72 hours. 91% of respondents thought Emergency Medicine physicians in the community should manage cases of straightforward priapism. The majority believed Emergency Medicine residents should be managing cases of acute ischemic priapism, either with Urology assistance (24.1%) or independently (56.9%). 29% preferred to be contacted by Emergency Medicine providers only after unsuccessful corporal aspiration and irrigation, and 39.7% only after unsuccessful intracavernosal injections. CONCLUSIONS Management of acute ischemic priapism overall appears relatively consistent, despite variation in initial therapy for priapism of longer durations. Many urologists use oral therapy despite national recommendations against this practice. There is strong support for independent management of straightforward acute ischemic priapism cases by Emergency Medicine physicians and trainees among urologists. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1125-e1126 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jessica Dai More articles by this author Omer Raheem More articles by this author Thomas Walsh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Internet usage among undergraduate nursing students: A case study of a selected university in South Africa

Background: Globally, the internet is becoming an increasingly indispensable tool in academic institutions and the workplace. Nursing students are required to use the computer and the internet to search for information and to use various software, for which computer and internet literacy are essential. Despite becoming an important tool for teaching and learning, literature reflects an under-utilization of the internet in academic and non-academic settings for a number of reasons. This article explores the general internet usage of undergraduate nursing students at a selected university in South Africa.Methods: A quantitative, non-experimental, exploratory descriptive design was used, with 115 undergraduate nursing students participating in the study. Data was collected using a questionnaire survey after obtaining ethical clearance from the university’s ethics committee and were analysed descriptively.Results: The findings revealed that the internet was used for various purposes including; academic (96.5%); communication (82.6%), pleasure (71.3%), and work-related activity (53.9%). Facebook (77.4%) was the most commonly used social network. Constraints encountered in using Barriers to the use of the internet include restriction of access to certain sites (62.6%), very slow internet connection (55.7%), little training on how to use internet facilities (38.3%), and a limited number of computers (37.4%).Conclusions: Contrary to other studies, this study shows that students do use the internet for a number of reasons, and recommend structured support on how to use if for academic purposes.

Clinical Feasibility Assessment of T3 Sub-Stage in Rectal Cancer Using MRI

Background: MRI predicted distance of mesorectal extension (mrDME) in rectal cancer is one of the independent risk factors for recurrence and poor overall survival. In T3 rectal cancer, if no lymph node or distant metastasis is seen, the selection of optimum treatment is based on the distance of mesorectal extension. Therefore, it is very crucial to investigate the reproducibility of DME in T3 rectal cancer. Objectives: To investigate the reproducibility of the distance of mesorectal extension by tumor invasion in T3 stage rectal cancer by evaluating sub-stages T3a, T3b T3c and T3d individually versus T3a, T3b (T3ab) and T3c, T3d (T3cd) combined together using MRI. Patients and Methods: From July 2014 to December 2015, 188 patients with surgically and histologically confirmed T3 rectal cancer who underwent preoperative MRI were enrolled into this study. Two blinded radiologists evaluated the maximum distance of mesorectal extension (mrDME) in T2 weighted image in MRI. The study population was sub classified into T3a ( 15 mm) according to the distance of mesorectal extension by tumor invasion. The inter-observer and intra-observer agreements were then assessed using kappa (k) coefficient of agreement and intraclass correlation coefficient (ICC). Results: Difference in the value of inter-/intra-observer kappa, and inter-/intra-observer ICC between the two groups was very distinct. In the individual group (T3a, T3b, T3c and T3d), the inter-observer and intra-observer (k) for the mrDME was 0.700 and 0.718 respectively; the inter-observer and intra-observer ICC was 0.772 and 0.786 respectively. In the combined group (T3ab and T3cd), the inter-observer and intra-observer kappa (k) for the mrDME was 0.819 and 0.883 respectively; the inter-observer and intra-observer ICC was 0.829 and 0.796 respectively. Conclusion: There was a distinct increase in the kappa and ICC value in the combined group compared with the individual group. This high reproducibility result suggested that it is more reliable to measure T3ab and T3cd combined together than individually. This finding can play a crucial role in the management of rectal cancer and clinical decision making for non-expert radiologists in non-academic setting.

Journeys in big data statistics

The realm of big data is a very wide and varied one. We discuss old, new, small and big data, with some of the important challenges including dealing with highly-structured and object-oriented data. In many applications the objective is to discern patterns and learn from large datasets of historical data. We shall discuss such issues in some transportation network applications in non-academic settings, which are naturally applicable to other situations. Vital aspects include dealing with logistics, coding and choosing appropriate statistical methodology, and we provide a summary and checklist for wider implementation.

Development and Implementation of a Combined Master of Science and PGY1/PGY2 Health-System Pharmacy Administration Residency Program at a Large Community Teaching Hospital.

Purpose: The purpose of this article is to share experiences after the development of a health-system pharmacy administration residency with a MS degree and express the need for additional programs in nonacademic medical center health-system settings. Summary: Experiences with the development and implementation of a health-system pharmacy administration residency at a large community teaching hospital are described. Resident candidates benefit from collaborations with other health-systems through master's degree programs and visibility to leaders at your health-system. Programs benefit from building a pipeline of future pharmacy administrators and by leveraging the skills of residents to contribute to projects and department-wide initiatives. Tools to assist in the implementation of a new pharmacy administration program are also described and include rotation and preceptor development, marketing and recruiting, financial evaluation, and steps to prepare for accreditation. Conclusion: Health-system pharmacy administration residents provide the opportunity to build a pipeline of high-quality leaders, provide high-level project involvement, and produce a positive return on investment (ROI) for health-systems. These programs should be explored in academic and nonacademic-based health-systems.

Provider Types and Outcomes in Obstructive Sleep Apnea Case Finding and Treatment: A Systematic Review.

Obstructive sleep apnea (OSA) diagnosis and care models rely on sleep specialist physicians (SSPs) and can be expensive and inefficient. To assess OSA case-finding accuracy and comparative effectiveness of care by non-sleep specialists (NSSs) and SSPs. MEDLINE and CINAHL from January 2000 through July 2017. English-language trials or observational studies comparing case finding or care by SSPs versus providers not specifically trained as SSPs (NSSs) for adults with suspected or diagnosed OSA. One investigator extracted data and assessed risk of bias and strength of evidence, with confirmation by a second investigator. Primary outcomes were patient-centered (mortality, access to care, quality of life, patient satisfaction, adherence, symptom scores, and adverse events). Intermediate outcomes included resource use, costs, time to initiation of treatment, and case finding. Four observational studies (n= 580; mean age, 52 years; 77% male) reported good agreement between NSSs and SSPs on appropriate diagnostic testing and classification of OSA severity (low-strength evidence). Five randomized trials and 3 observational studies (n= 1515; mean age, 52 years; 68% male) found that care provided by NSSs and SSPs resulted in similar quality of life, adherence, and symptom scores (low-strength evidence). Evidence was insufficient for access to care and adverse events. Many outcomes were reported infrequently or not at all. Many NSSs had extensive training or experience in sleep medicine, which limits generalizability of findings to providers with less experience. Care by NSSs and SSPs resulted in similar outcomes in adults with known or suspected OSA. Studies are needed to determine care model implementation and reproducibility of results in nonacademic settings and among less experienced NSSs. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. (PROSPERO: CRD42016036810 [full Veterans Affairs Evidence-based Synthesis Program report]).

Critical Care Organizations: Business of Critical Care and Value/Performance Building.

New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1). The goal of this article was to provide a roadmap and call attention to key factors that adult critical care medicine leadership in both academic and nonacademic setting should consider when planning for value-based care. Relevant medical literature was accessed through a literature search. Material published by federal health agencies and other specialty organizations was also reviewed. Collaboratively and iteratively, taskforce members corresponded by electronic mail and held monthly conference calls to finalize this report. The business and value/performance critical care organization building section comprised of leaders of critical care organizations with expertise in critical care administration, healthcare management, and clinical practice. Two phases of critical care organizations care integration are described: "horizontal," within the system and regionalization of care as an initial phase, and "vertical," with a post-ICU and postacute care continuum as a succeeding phase. The tools required for the clinical and financial transformation are provided, including the essential prerequisites of forming a critical care organization; the manner in which a critical care organization can help manage transformational domains is considered. Lastly, how to achieve organizational health system support for critical care organization implementation is discussed. A critical care organization that incorporates functional clinical horizontal and vertical integration for ICU patients and survivors, aligns strategy and operations with those of the parent health system, and encompasses knowledge on finance and risk will be better positioned to succeed in the value-based world.

Arabic Readability Research: Current State and Future Directions

We provide a perspective on the current state of Arabic readability assessment research with the objective of considering directions and opportunities for future research. We review and assess the current state of progress in Arabic readability assessment, briefly surveying research that has been performed on texts targeted at different populations: readers of Arabic as L1, adult readers in non-academic settings, and readers of Arabic as L2. Arabic readability assessment has followed trends in other languages, primarily English, but has faced challenges due to the specificities of Arabic and the relative scarcity of available corpora and tools, compared to languages with richer resources. We also consider whether readability assessment for Arabic should take into consideration the special situation of diglossia that exists in all Arab countries.

On-line Appendix for 'Academic Entrepreneurship: Bayh-Dole versus the Professor’s Privilege'

Is the Bayh-Dole intellectual property regime associated with more and better academic entrepreneurship than the Professor Privilege regime? The authors examine data on US PhDs in the natural sciences, engineering, and medical fields who became entrepreneurs in 1993–2006 and compare this to similar data from Sweden. They find that, in both countries, those with an academic background have lower rates of entry into entrepreneurship than do those with a non-academic background. The relative rate of academics starting entrepreneurial firms is slightly lower in the United States than in Sweden. Moreover, the mean economic gains from becoming an entrepreneur are negative, both for PhDs originating in academia and non-academic settings in both countries. Analysis indicates that selection into entrepreneurship occurs from the lower part of the ability distribution among academics. The results suggest that policies aimed at supporting entrepreneurial decisions by younger, tenure-track academics may be more effective than general incentives at increasing academic entrepreneurship in general.

Using a Logic Model to Direct Backward Design of Curriculum.

Contemporary approaches to STEM course design typically encourage the backward design of curricula. This is to say that the learning activities and assessments of the course are explicitly guided by the learning outcomes of the course. Less discussed is the fact that this paradigm is also used in nonacademic settings. From this perspective, drawing from the nonacademic world, we discuss the use of a logic model approach as a structured, orderly way to implement backward design. We use the design and implementation of an introductory biology class to illustrate how a logic model template helped frame our inclusive, Freirean approach to teaching and learning.

Performance characteristics of multiparametric-MRI at a non-academic hospital using transperineal template mapping biopsy as a reference standard

ObjectivesTo evaluate diagnostic accuracy of mpMRI in a non-academic hospital using transperineal template prostate mapping (TPM) biopsy as a reference standard. Secondary objectives included evaluating why mpMRI missed significant cancer. Materials and methods101 men received pre-biopsy mpMRI and TPM-biopsy over 16 months. Disease status was assigned at hemigland level. Primary histological definition of clinical significance was Gleason grade >/ = 4 + 3 or maximum cancer core length (MCCL) >/ = 6 mm. Positive mpMRI was defined as Prostate Imaging Reporting and Data System (PI-RADS) score >/ = 3. ResultsMedian age 69 (IQR 62–76). Median PSA 7 ng/ml (IQR 4.6–9.8). mpMRI had sensitivity 76.9%, specificity 60.7%, PPV 40.4% and NPV 88.3% at primary definitions. For detecting any Gleason >/ = 7 mpMRI had sensitivity 73.2%, specificity 60.3%, PPV 41.4% and NPV 85.4%. Mean MCCL was lower where significant cancer was missed compared to those correctly identified (5.8 mm versus 7.7 mm respectively, p = 0.035). ConclusionmpMRI performance characteristics were very encouraging when compared to contemporary clinical trials. In a non-academic hospital setting, negative mpMRI was just as good at ruling-out significant disease, though the ability of positive mpMRI to accurately detect significant disease was lower. An mpMRI-guided diagnostic pathway should be accompanied by appropriate mpMRI protocol optimisation, training, and quality control.

Assessing physician awareness of the Choosing Wisely Canada recommendations

Assessing physician awareness of the Choosing Wisely Canada recommendations

Culture Shocks Experienced by Indonesian Students Studying Overseas

This qualitative study is aimed at investigating culture shocks experienced by Indonesian students studying overseas in both academic and non-academic settings. It is intended to answer three research questions: 1) What stages of culture shocks did they experience?; 2) How did culture shocks affect their life?; 3) How did they solve the problems of culture shocks? Data were collected by distributing a questionnaire to 40 respondents and conducting an in-depth interview with selected respondents. Data were analyzed by categorizing information, sorting out similar information, and interpreting information. The data were validated by triangulation, member checks, and as clear description as possible. The findings showed that the students experienced culture shock in varying levels; initial euphoria, irritation, gradual adjustment, acceptance and integration. The study revealed that language was the most problematic aspect experienced by the students. Culture shocks affected students’ life in both academic and non-academic settings. Lack of confidence in class participation was the effect of culture shocks experienced by most of the students because of the language problem. To survive in host country, students solved the problems through various activities, such as by interacting with Indonesian people staying in host country, communicating with family and friends, consulting lecturers, academic advisor and counselor, tolerating with cultural differences, understanding host culture as well as introducing Indonesian culture, having positive attitude towards culture shocks, writing journals, and keeping physically and mentally healthy.

Game-Based Learning and Information Literacy

In the 21st century, students have access to a plethora of information. As such, the skills required to access and effectively sort through this information (information literacy skills) become ever more important for success in both academic and non-academic settings. This study sought to assess the efficacy of two educational games designed to increase high school students' information literacy skills. Using a randomized controlled trial in a high school setting, the games were integrated into a standard curriculum and tested for efficacy. Post-test results indicated that both games effectively transmit targeted skills. Additionally, improved performance (relative to controls) on end-of-instruction testing (EOI; end-of-year state testing) suggest that these skills transfer across important academic domains. The study provides strong evidence to support the use of these two educational games to supplement and enhance information literacy instruction.

A5166 - Bariatric Case Mix in Academic vs. Non-Academic Practice Settings

A5166 - Bariatric Case Mix in Academic vs. Non-Academic Practice Settings

Twelve tips on how to compile a medical educator’s portfolio

Medical education is an expanding area of specialist interest for medical professionals. Whilst most doctors will be familiar with the compilation of clinical portfolios for scrutiny of their clinical practice and provision of public accountability, teaching portfolios used specifically to gather and demonstrate medical education activity remain uncommon in many non-academic settings. For aspiring and early career medical educators in particular, their value should not be underestimated. Such a medical educator's portfolio (MEP) is a unique compendium of evidence that is invaluable for appraisal, revalidation, and promotion. It can stimulate and provide direction for professional development, and is a rich source for personal reflection and learning. We recommend that all new and aspiring medical educators prepare an MEP, and suggest twelve tips on how to skillfully compile one.

Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling

BackgroundScreening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics. This study explored whether an interactive, web-based genetics curriculum directed at PCPs in non-academic primary care settings was superior at changing practice knowledge, attitudes, and behaviors when compared to a traditional educational approach, particularly when discussing common genetic conditions.MethodsOne hundred twenty one PCPs in California and Pennsylvania physician practices were randomized to either an Intervention Group (IG) or Control Group (CG). IG physicians completed a 6 h interactive web-based curriculum covering communication skills, basics of genetic testing, risk assessment, ELSI issues and practice behaviors. CG physicians were provided with a traditional approach to Continuing Medical Education (CME) (clinical review articles) offering equivalent information.ResultsPCPs in the Intervention Group showed greater increases in knowledge compared to the Control Group. Intervention PCPs were also more satisfied with the educational materials, and more confident in their genetics knowledge and skills compared to those receiving traditional CME materials. Intervention PCPs felt that the web-based curriculum covered medical management, genetics, and ELSI issues significantly better than did the Control Group, and in comparison with traditional curricula. The Intervention Group felt the online tools offered several advantages, and engaged in better shared decision making with standardized patients, however, there was no difference in behavior change between groups with regard to increases in ELSI discussions between PCPs and patients.ConclusionWhile our intervention was deemed more enjoyable, demonstrated significant factual learning and retention, and increased shared decision making practices, there were few differences in behavior changes around ELSI discussions. Unfortunately, barriers to implementing behavior change in clinical genetics is not unique to our intervention. Perhaps the missing element is that busy physicians need systems-level support to engage in meaningful discussions around genetics issues. The next step in promoting active engagement between doctors and patients may be to put into place the tools needed for PCPs to easily access the materials they need at the point-of-care to engage in joint discussions around clinical genetics.

A new method for early detection of infants at risk of long-term neuromotor disabilities

General movements (GM) are used in academic settings to predict developmental outcome in infants born preterm. However, little is known about the implementation and predictive value of GM in non-academic settings.The aim of this study is twofold: To document the implementation of GM assessment (GMA) in a non-academic setting and to assess its predictive value in infants born preterm.We documented the process of implementing GMA in a non-academic outpatient clinic. In addition, we assessed the predictive value of GMA at 1 and 3 months’ corrected age for motor and cognitive development at 2 years in 122 children born <33 weeks’ gestation. Outcome at two years was based upon the Bayley Scales of Infant Development-II (mental/psychomotor developmental index (MDI, PDI)) and a neurological examination. The infants’ odds of atypical outcome (MDI or PDI ≤70 or diagnosis CP) and the predictive accuracy of abnormal GMA were calculated in a clinical routine scenario, which used all available GM information (primarily at 3 months or at 1 month, when 3 months were not available). In addition, separate analysis was undertaken for the samples of GMA at 1 and 3 months.Tips to facilitate GMA implementation are described. In our clinical routine scenario, children with definitely abnormal GM were more likely to have an atypical two-year outcome than children with normal GM (OR 13.2 (95% CI 1.56; 112.5); sensitivity 55.6%, specificity 82.1%). Definitely abnormal GM were associated with reduced MDI (−12.0, 95% CI −23.2; −0.87) and identified all children with cerebral palsy (CP) in the sample of GMA at 3 months only.GMA can be successfully implemented in a non-academic outpatient setting. In our clinical routine scenario, GMA allowed for adequate prediction of neurodevelopment in infants born preterm, thereby allaying concerns about diagnostic accuracy in non-academic settings.