1
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Weiler DT, Lingg AJ, Eagan BR, Shaffer DW, Werner NE. Quantifying the qualitative: exploring epistemic network analysis as a method to study work system interactions. Ergonomics 2022; 65:1434-1449. [PMID: 35258441 PMCID: PMC9489604 DOI: 10.1080/00140139.2022.2051609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 02/28/2022] [Indexed: 06/04/2023]
Abstract
Studying interactions faces methodological challenges and existing methods, such as configural diagramming, have limitations. This work demonstrates Epistemic Network Analysis (ENA) as an analytical method to construct configural diagrams. We demonstrated ENA as an analytical tool by applying this method to study dementia caregiver work systems. We conducted 20 semi-structured interviews with caregivers to collect caregiving experiences. Guided by the Patient Work System model, we conducted a directed content analysis to identify work system components and used ENA to study interactions between components. By using ENA to create configural diagrams, we identified five frequently occurring interactions, compared work system configurations of caregivers providing care at home and away from home. Although we were underpowered to determine statistically significant differences, we identified visual and qualitative differences. Our results demonstrate the capability of ENA as an analytical method for studying work system interactions through configural diagramming. Practitioner summary: A new methodology, Epistemic Network Analysis (ENA), was presented to better support the study of work system interactions through configural diagramming. ENA was applied to qualitative data to demonstrate the capabilities of this method to construct configural diagrams of the work system. This study successfully demonstrated that ENA can visually represent and describe work system configurations.
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Affiliation(s)
- Dustin T. Weiler
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, USA
| | - Aloysius J. Lingg
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, USA
| | - Brendan R. Eagan
- Department of Educational Psychology and Wisconsin Center for Education Research, University of Wisconsin-Madison, USA
| | - David W. Shaffer
- Department of Educational Psychology and Wisconsin Center for Education Research, University of Wisconsin-Madison, USA
| | - Nicole E. Werner
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, USA
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2
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Bhowmick I, Shaffer DW, Yang JY, Shores MP. Single molecule magnet behaviour in a square planar S = 1/2 Co(ii) complex and spin-state assignment of multiple relaxation modes. Chem Commun (Camb) 2020; 56:6711-6714. [PMID: 32420553 DOI: 10.1039/d0cc01854f] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report the first example of field-induced single molecule magnet (SMM) behaviour in a square-planar S = 1/2 Co(ii) pincer complex [(PNNNP)CoBr]Br (2). The related five-coordinate complexes [(PCNCP)CoBr2] (1) and [(PONOP)CoBr2] (3) also exhibit SMM properties. Partial spin crossover displayed by 3 allows for assignment of distinct relaxation modes to each spin state.
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Affiliation(s)
- Indrani Bhowmick
- Department of Chemistry, Colorado State University, Fort Collins, CO 80523-1872, USA.
| | - David W Shaffer
- Department of Chemistry, University of California, Irvine, CA 92697, USA and MacDermid Alpha Electronics Solutions, 193 Marsh Hill Rd, Orange, CT 06477, USA
| | - Jenny Y Yang
- Department of Chemistry, University of California, Irvine, CA 92697, USA
| | - Matthew P Shores
- Department of Chemistry, Colorado State University, Fort Collins, CO 80523-1872, USA.
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3
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Wang L, Shaffer DW, Manbeck GF, Polyansky DE, Concepcion JJ. High-Redox-Potential Chromophores for Visible-Light-Driven Water Oxidation at Low pH. ACS Catal 2019. [DOI: 10.1021/acscatal.9b04034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Lei Wang
- Department of Materials Science and Chemical Engineering, Stony Brook University, Stony Brook, New York 11794, United States
| | | | - Gerald F. Manbeck
- Chemistry Division, Brookhaven National Laboratory, Upton, New York 11973, United States
| | - Dmitry E. Polyansky
- Chemistry Division, Brookhaven National Laboratory, Upton, New York 11973, United States
| | - Javier J. Concepcion
- Chemistry Division, Brookhaven National Laboratory, Upton, New York 11973, United States
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4
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Xie Y, Shaffer DW, Concepcion JJ. O–O Radical Coupling: From Detailed Mechanistic Understanding to Enhanced Water Oxidation Catalysis. Inorg Chem 2018; 57:10533-10542. [DOI: 10.1021/acs.inorgchem.8b00329] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yan Xie
- Chemistry Division, Brookhaven National Laboratory, Upton, New York 11973, United States
| | - David W. Shaffer
- Chemistry Division, Brookhaven National Laboratory, Upton, New York 11973, United States
| | - Javier J. Concepcion
- Chemistry Division, Brookhaven National Laboratory, Upton, New York 11973, United States
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5
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Shaffer DW, Xie Y, Szalda DJ, Concepcion JJ. Lability and Basicity of Bipyridine-Carboxylate-Phosphonate Ligand Accelerate Single-Site Water Oxidation by Ruthenium-Based Molecular Catalysts. J Am Chem Soc 2017; 139:15347-15355. [DOI: 10.1021/jacs.7b06096] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- David W. Shaffer
- Chemistry
Division, Brookhaven National Laboratory, Upton, New York 11973-5000, United States
| | - Yan Xie
- Chemistry
Division, Brookhaven National Laboratory, Upton, New York 11973-5000, United States
| | - David J. Szalda
- Department
of Natural Sciences, Baruch College, CUNY, New York, New York 10010, United States
| | - Javier J. Concepcion
- Chemistry
Division, Brookhaven National Laboratory, Upton, New York 11973-5000, United States
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6
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Shaffer DW, Xie Y, Concepcion JJ. O–O bond formation in ruthenium-catalyzed water oxidation: single-site nucleophilic attack vs. O–O radical coupling. Chem Soc Rev 2017; 46:6170-6193. [DOI: 10.1039/c7cs00542c] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A review of water oxidation by ruthenium-based molecular catalysts, with emphasis on the mechanism of O–O bond formation.
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Affiliation(s)
| | - Yan Xie
- Chemistry Division
- Brookhaven National Laboratory
- Upton
- USA
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7
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Shaffer DW, Xie Y, Szalda DJ, Concepcion JJ. Manipulating the Rate-Limiting Step in Water Oxidation Catalysis by Ruthenium Bipyridine–Dicarboxylate Complexes. Inorg Chem 2016; 55:12024-12035. [DOI: 10.1021/acs.inorgchem.6b02193] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
| | | | - David J. Szalda
- Department
of Natural Sciences, Baruch College, The City University of New York, New
York, New York 10010, United States
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8
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Xie Y, Shaffer DW, Lewandowska‐Andralojc A, Szalda DJ, Concepcion JJ. Water Oxidation by Ruthenium Complexes Incorporating Multifunctional Bipyridyl Diphosphonate Ligands. Angew Chem Int Ed Engl 2016. [DOI: 10.1002/ange.201601943] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yan Xie
- Chemistry Division Brookhaven National Laboratory Upton NY 11973-5000 USA
| | - David W. Shaffer
- Chemistry Division Brookhaven National Laboratory Upton NY 11973-5000 USA
| | - Anna Lewandowska‐Andralojc
- Chemistry Division Brookhaven National Laboratory Upton NY 11973-5000 USA
- Faculty of Chemistry Adam Mickiewicz University Umultowska 89b 61614 Poznan Poland
| | - David J. Szalda
- Department of Natural Sciences Baruch College, CUNY New York NY 10010 USA
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9
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Xie Y, Shaffer DW, Lewandowska-Andralojc A, Szalda DJ, Concepcion JJ. Water Oxidation by Ruthenium Complexes Incorporating Multifunctional Bipyridyl Diphosphonate Ligands. Angew Chem Int Ed Engl 2016; 55:8067-71. [PMID: 27166584 DOI: 10.1002/anie.201601943] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/28/2016] [Indexed: 11/05/2022]
Abstract
We describe herein the synthesis and characterization of ruthenium complexes with multifunctional bipyridyl diphosphonate ligands as well as initial water oxidation studies. In these complexes, the phosphonate groups provide redox-potential leveling through charge compensation and σ donation to allow facile access to high oxidation states. These complexes display unique pH-dependent electrochemistry associated with deprotonation of the phosphonic acid groups. The position of these groups allows them to shuttle protons in and out of the catalytic site and reduce activation barriers. A mechanism for water oxidation by these catalysts is proposed on the basis of experimental results and DFT calculations. The unprecedented attack of water at a neutral six-coordinate [Ru(IV) ] center to yield an anionic seven-coordinate [Ru(IV) -OH](-) intermediate is one of the key steps of a single-site mechanism in which all species are anionic or neutral. These complexes are among the fastest single-site catalysts reported to date.
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Affiliation(s)
- Yan Xie
- Chemistry Division, Brookhaven National Laboratory, Upton, NY, 11973-5000, USA
| | - David W Shaffer
- Chemistry Division, Brookhaven National Laboratory, Upton, NY, 11973-5000, USA
| | - Anna Lewandowska-Andralojc
- Chemistry Division, Brookhaven National Laboratory, Upton, NY, 11973-5000, USA.,Faculty of Chemistry, Adam Mickiewicz University, Umultowska 89b, 61614, Poznan, Poland
| | - David J Szalda
- Department of Natural Sciences, Baruch College, CUNY, New York, NY, 10010, USA
| | - Javier J Concepcion
- Chemistry Division, Brookhaven National Laboratory, Upton, NY, 11973-5000, USA.
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10
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Shaffer DW, Bhowmick I, Rheingold AL, Tsay C, Livesay BN, Shores MP, Yang JY. Spin-state diversity in a series of Co(ii) PNP pincer bromide complexes. Dalton Trans 2016; 45:17910-17917. [DOI: 10.1039/c6dt03461f] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We describe the structural and electronic impacts of modifying the bridging atom in a family of Co(ii) pincer complexes with the formula Co(t-Bu)2PEPyEP(t-Bu)2Br2 (Py = pyridine, E = CH2, NH, and O for compounds 1–3, respectively).
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Affiliation(s)
| | | | | | - Charlene Tsay
- Department of Chemistry
- University of California
- Irvine
- USA
| | - Brooke N. Livesay
- Department of Chemistry
- Colorado State University
- Fort Collins
- USA
- Department of Chemistry
| | | | - Jenny Y. Yang
- Department of Chemistry
- University of California
- Irvine
- USA
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11
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Shaffer DW, Johnson SI, Rheingold AL, Ziller JW, Goddard WA, Nielsen RJ, Yang JY. Reactivity of a Series of Isostructural Cobalt Pincer Complexes with CO2, CO, and H+. Inorg Chem 2014; 53:13031-41. [DOI: 10.1021/ic5021725] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David W. Shaffer
- Department of Chemistry, University of California, Irvine, 1102 Natural Sciences 2, Irvine, California 92697, United States
| | - Samantha I. Johnson
- Joint Center for Artificial Photosynthesis, California Institute of Technology, Pasadena, California 91125, United States
- Department
of Chemistry, California Institute of Technology, Pasadena, California 91125, United States
| | - Arnold L. Rheingold
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, California 92093, United States
| | - Joseph W. Ziller
- Department of Chemistry, University of California, Irvine, 1102 Natural Sciences 2, Irvine, California 92697, United States
| | - William A. Goddard
- Joint Center for Artificial Photosynthesis, California Institute of Technology, Pasadena, California 91125, United States
- Department
of Chemistry, California Institute of Technology, Pasadena, California 91125, United States
| | - Robert J. Nielsen
- Joint Center for Artificial Photosynthesis, California Institute of Technology, Pasadena, California 91125, United States
- Department
of Chemistry, California Institute of Technology, Pasadena, California 91125, United States
| | - Jenny Y. Yang
- Department of Chemistry, University of California, Irvine, 1102 Natural Sciences 2, Irvine, California 92697, United States
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12
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Shaffer DW, Szigethy G, Ziller JW, Heyduk AF. Synthesis and Characterization of a Redox-Active Bis(thiophenolato)amide Ligand, [SNS]3–, and the Homoleptic Tungsten Complexes, W[SNS]2 and W[ONO]2. Inorg Chem 2013; 52:2110-8. [DOI: 10.1021/ic302506e] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- David W. Shaffer
- Department of Chemistry, University of California, Irvine, California, 92697, United States
| | - Géza Szigethy
- Department of Chemistry, University of California, Irvine, California, 92697, United States
| | - Joseph W. Ziller
- Department of Chemistry, University of California, Irvine, California, 92697, United States
| | - Alan F. Heyduk
- Department of Chemistry, University of California, Irvine, California, 92697, United States
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13
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Affiliation(s)
- David W. Shaffer
- Department
of Chemistry, University of California,
Irvine, California 92697-2025, United States
| | - Scott A. Ryken
- Department
of Chemistry, University of California,
Irvine, California 92697-2025, United States
| | - Ryan A. Zarkesh
- Department
of Chemistry, University of California,
Irvine, California 92697-2025, United States
| | - Alan F. Heyduk
- Department
of Chemistry, University of California,
Irvine, California 92697-2025, United States
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14
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Szigethy G, Shaffer DW, Heyduk AF. Coordination Effects on Electron Distributions for Rhodium Complexes of the Redox-Active Bis(3,5-di-tert-butyl-2-phenolate)amide Ligand. Inorg Chem 2012; 51:12606-18. [DOI: 10.1021/ic2026076] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Géza Szigethy
- Department of Chemistry, University of California, Irvine, California 92697,
United States
| | - David W. Shaffer
- Department of Chemistry, University of California, Irvine, California 92697,
United States
| | - Alan F. Heyduk
- Department of Chemistry, University of California, Irvine, California 92697,
United States
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15
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Affiliation(s)
- David W. Shaffer
- Department of Chemistry, University of California, Irvine (UCI), California 92697-2025
| | - Scott A. Ryken
- Department of Chemistry, University of California, Irvine (UCI), California 92697-2025
| | - Ryan A. Zarkesh
- Department of Chemistry, University of California, Irvine (UCI), California 92697-2025
| | - Alan F. Heyduk
- Department of Chemistry, University of California, Irvine (UCI), California 92697-2025
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16
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Gordon JA, Shaffer DW, Raemer DB, Pawlowski J, Hurford WE, Cooper JB. A randomized controlled trial of simulation-based teaching versus traditional instruction in medicine: a pilot study among clinical medical students. Adv Health Sci Educ Theory Pract 2006; 11:33-9. [PMID: 16583282 DOI: 10.1007/s10459-004-7346-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2004] [Accepted: 12/07/2004] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To compare simulator-based teaching with traditional instruction among clinical medical students. METHODS Randomized controlled trial with written pre-post testing. Third-year medical students (n = 38) received either a myocardial infarction (MI) simulation followed by a reactive airways disease (RAD) lecture, or a RAD simulation followed by an MI lecture. RESULTS Mean pre-post test score improvement was seen across teaching modalities (overall change score [simulation] = 8.8 [95% CI = 2.3-15.3], pretest [62.7]; change score [lecture] = 11.3 [95% CI = 5.7-16.9], pretest [59.7]). However, no significant differences were observed between simulator-based teaching and lecture, in either subject domain. CONCLUSIONS After a single instructional session for clinical medical students, differences between simulator-based teaching and lecture could not be established by the written test protocols used in this pilot. Future studies should consider the effects of iterative exposure assessed by clinical performance measures across multiple centers.
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17
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Gordon JA, Tancredi DN, Binder WD, Wilkerson WM, Shaffer DW. Assessment of a clinical performance evaluation tool for use in a simulator-based testing environment: a pilot study. Acad Med 2003; 78:S45-S47. [PMID: 14557093 DOI: 10.1097/00001888-200310001-00015] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE This study assessed a clinical performance evaluation tool for use in a simulator-based testing environment. METHOD Twenty-three subjects were evaluated during five standardized encounters using a patient simulator (six emergency medicine students, seven house officers, ten chief resident-fellows). Performance in each 15-minute session was compared with performance on an identical number of oral objective-structured clinical examination (OSCE) sessions used as controls. Each was scored by a faculty rater using a scoring system previously validated for oral certification examinations in emergency medicine (eight skills rated 1-8; passing = 5.75). RESULTS On both simulator exams and oral controls, chief resident-fellows earned (mean) "passing" scores [sim = 6.4 (95% CI: 6.0-6.8), oral = 6.4 (95% CI: 6.1-6.7)]; house officers earned "borderline" scores [sim = 5.6 (95% CI: 5.2-5.9), oral = 5.5 (95% CI: 5.0-5.9)]; and students earned "failing" scores [sim = 4.3 (95% CI: 3.8-4.7), oral = 4.5 (95% CI: 3.8-5.1)]. There were significant differences among mean scores for the three cohorts, for both oral and simulator test arms (p <.01). CONCLUSIONS In this pilot, a standardized oral OSCE scoring system performed equally well in a simulator-based testing environment.
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Affiliation(s)
- James A Gordon
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston 02114, USA.
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18
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Gordon JA, Wilkerson WM, Shaffer DW, Armstrong EG. "Practicing" medicine without risk: students' and educators' responses to high-fidelity patient simulation. Acad Med 2001; 76:469-72. [PMID: 11346525 DOI: 10.1097/00001888-200105000-00019] [Citation(s) in RCA: 193] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE To understand the responses of medical students and educators to high-fidelity patient simulation, a new technology allowing "practice without risk." METHOD Pilot groups of students (n = 27) and educators (n = 33) were exposed to a simulator session, then surveyed with multiple-choice and open-ended questions. Open-ended comments were transcribed and coded. They were analyzed for recurring themes and tested for inter-rater agreement. An independent focus group subsequently performed higher-level thematic analysis. RESULTS Overall, 85% of the students rated the session excellent and 85% of the educators rated it excellent or very good. Over 80% of both groups thought that simulator-based training should be required for all medical students. Analytic categories derived from written comments were: Overall Assessment (i.e., "generally good experience"); Process Descriptors (i.e., "very realistic"); Teaching Utility (i.e., "broad educational tool"); Pedagogic Efficacy (i.e., "promotes critical thinking"); and Goals for Future Use (i.e., "more practice sessions"). Thirty percent of students and 38% of educators were impressed by the realism of the simulator, and they (37% and 25%, respectively) identified the ability to "practice" medicine as the primary advantage of simulation. The focus group rated cost as the major current disadvantage (66%). CONCLUSIONS Students' and educators' responses to high-fidelity patient simulation were very positive. The ability to practice without risk must be weighed against the cost of this new technology.
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Affiliation(s)
- J A Gordon
- Division of Emergency Medicine, Harvard Medical School, Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, CLN 115, Boston, MA 02114-2696, USA.
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19
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Abstract
Interventional cardiology training traditionally involves one-on-one experience following a master-apprentice model, much as other procedural disciplines. Development of a realistic computer-based training system that includes hand-eye coordination, catheter and guide wire choices, three-dimensional anatomic representations, and an integrated learning system is desirable, in order to permit learning to occur safely, without putting patients at risk. Here we present the first report of a PC-based simulator that incorporates synthetic fluoroscopy, real-time three-dimensional interactive anatomic display, and selective right- and left-sided coronary catheterization and angiography using actual catheters. Significant learning components also are integrated into the simulator.
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Affiliation(s)
- S L Dawson
- Center for Innovative Minimally Invasive Therapy, Boston, Massachusetts, USA.
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20
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Cotin S, Dawson SL, Meglan D, Shaffer DW, Ferrell MA, Bardsley RS, Morgan FM, Nagano T, Nikom J, Sherman P, Walterman MT, Wendlandt J. ICTS, an interventional cardiology training system. Stud Health Technol Inform 2000; 70:59-65. [PMID: 10977584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
In this article, we present an Interventional Cardiology Training System developed by the Medical Application Group at Mitsubishi Electric in collaboration with the Center for Innovative Minimally Invasive Therapy. The core of the ICTS is a computer simulation of interventional cardiology catheterization. This simulation integrates clinical expertise, research in learning, and technical innovations to create a realistic simulated environment. The goal of this training system is to augment the training of new cardiology fellows as well as to introduce cardiologists to new devices and procedures. To achieve this goal, both the technical components and the educational content of the ICTS bring new and unique features: a simulated fluoroscope, a physics model of a catheter, a haptic interface, a fluid flow simulation combined with a hemodynamic model and a learning system integrated in a user interface. The simulator is currently able to generate--in real-time--high quality x-ray images from a 3D anatomical model of the thorax, including a beating heart and animated lungs. The heart and lung motion is controlled by the hemodynamic model, which also computes blood pressure and EKG. The blood flow is then calculated according to the blood pressure and blood vessel characteristics. Any vascular tool, such as a catheter, guide wire or angioplasty balloon can be represented and accurately deformed by the flexible tool physics model. The haptics device controls the tool and provides appropriate feedback when contact with a vessel wall is detected. When the catheter is in place, a contrast agent can be injected into the coronary arteries; blood and contrast mixing is computed and a visual representation of the angiogram is displayed by the x-ray renderer. By bringing key advances in the area of medical simulation--with the real-time x-ray renderer for instance--and by integrating in a single system both high quality simulation and learning tools, the ICTS opens new perspectives for computer based training systems.
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Affiliation(s)
- S Cotin
- Virtual Presence, Inc., Boston, MA, USA
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21
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Weiss GR, Shaffer DW, DeMoor C, Rinaldi DA, Rodriguez GI, Eckardt JR, Stephens C, Von Hoff DD. A randomized phase I study of oral etoposide with or without granulocyte-macrophage colony-stimulating factor for the treatment of patients with advanced cancer. Anticancer Drugs 1996; 7:402-9. [PMID: 8826608 DOI: 10.1097/00001813-199606000-00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to evaluate the feasibility of chronic oral administration of etoposide with granulocyte-macrophage colony-stimulating factor (GM-CSF) [sargramostim (Immunex)] coadministration or premedication; to estimate and compare the frequency of toxicities accompanying etoposide administration alone, etoposide/GM-CSF coadministration and etoposide with GM-CSF premedication. Thirty-nine patients with advanced treatment-refractory malignancies were enrolled to this study. Eligible patients were randomized to one of three treatment arms: daily oral etoposide alone for 21 days (arm A); daily oral etoposide for 21 days with GM-CSF, 250 micrograms/m2, s.c. twice daily for the first 10 days of etoposide administration (arm B); or daily oral etoposide for 21 days with GM-CSF twice daily for the sixth through second days preceding etoposide administration (arm C). Courses of treatment were repeated every 28 days. Etoposide dosages for each arm were 25, 50, 75 and 100 mg/m2/day. At least three patients were treated at each dosage level until dose-limiting toxicity was observed. Patients had twice weekly blood counts and weekly clinical examinations to assess toxicity. Patients with measurable or evaluable evidence of cancer were assessed for antitumor response after every other course of therapy. Nadir neutrophil counts at each dosage level were compared between treatment arms by non-parametric Wilcoxen rank sum tests. GM-CSF coadministration (arm B) or premedication (arm C) with daily chronic oral etoposide was feasible and did not lead to excessive hematological toxicity. Pairwise comparisons of neutrophil nadirs for the first course of therapy for each treatment arm did not demonstrate any significant differences and, at most, a slight trend favoring improved neutrophil nadirs was shown for arm C compared to arm A (p = 0.07). Dose intensity as measured by mean days of etoposide administered per patient for each arm suggested only slight improvement in etoposide tolerance for treatment arms B and C. The conclusion, GM-CSF can be safely administered to patients receiving chronic daily oral etoposide. It appears that GM-CSF provides no clinically useful improvement in granulocyte tolerance of therapy.
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Affiliation(s)
- G R Weiss
- Division of Medical Oncology, University of Texas Health Science Center at San Antonio 78284, USA
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Shaffer DW, Smith LS, Burris HA, Clark GM, Eckardt JR, Fields SM, Weiss GR, Rinaldi DA, Bowen KJ, Kuhn JG. A randomized phase I trial of chronic oral etoposide with or without granulocyte-macrophage colony-stimulating factor in patients with advanced malignancies. Cancer Res 1993; 53:5929-33. [PMID: 8261405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Data from an in vitro human tumor-cloning assay suggested synergistic cytotoxicity when etoposide (VP16) and granulocyte-macrophage colony-stimulating factor (GM-CSF) were combined. To explore this potential, we undertook a prospectively randomized three-arm trial in a phase I setting with various schedules of VP16 and GM-CSF. Thirty-one patients were enrolled in the three-arm trial. Arm A consisted of oral VP16 daily for up to 21 days with cycles repeated every 35 days. Arm B included oral VP16 daily for up to 21 days plus concomitant GM-CSF at 5 micrograms/kg/day s.c. days 1-10. Arm C included oral VP16 daily for up to 21 days plus pretreatment with GM-CSF at the same dose for 5 days (days -6 to -2). VP16 was begun at 25 mg/m2/day on level 1 and increased to 50 mg/m2/day on level 2. Twenty-seven patients were evaluable for toxicity, nine on each arm (six patients on each arm on level 1, three patients on each arm on level 2). Neutropenia on arm B (concomitant VP16 and GM-CSF) was earlier and more profound than on arm A or C. The median absolute neutrophil count and day of nadir for arms A, B, and C were 3295, 988, and 1600/mm3 and days 23, 15, and 26, respectively. Thrombocytopenia was generally uncommon except on arm C level 2, where the median platelet count was 26,000/mm3. One partial response (arm B) in a patient with non-small cell lung cancer was seen. Dose intensity favored arm A. Neither concomitant therapy with VP16 and GM-CSF (arm B) nor pretreatment with GM-CSF (arm C) improved dose intensity over VP16 alone (arm A), and arms B and C were complicated by increased neutropenia and thrombocytopenia.
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Affiliation(s)
- D W Shaffer
- Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6200
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Abstract
A case of multiple myeloma diagnosed by fine-needle aspiration (FNA) biopsy and confirmed by laboratory studies in a patient with a history of renal-cell carcinoma is presented. The patient was diagnosed with renal-cell carcinoma of the right kidney and a radical nephrectomy was performed. Eighteen months after this diagnosis was made, the patient developed chest wall pain and was found to have osteolytic bone lesions of the ribs and vertebral bodies. FNA of an osteolytic rib lesion disclosed multiple myeloma. Additional laboratory studies confirmed the diagnosis of multiple myeloma. This case report demonstrates the value of FNA as a diagnostic tool for the follow-up of cancer patients, the subsequent discrimination between metastatic lesions and a second primary malignancy, and the cytology of multiple myeloma.
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Affiliation(s)
- G L Cooper
- Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, TX
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Abstract
Testicular relapse (TR) in adult acute myelogenous leukemia (AML) is uncommon, occurring in only 1-2% of patients with bone marrow relapse. TR in the absence of systemic relapse has been reported previously in 2 adults and 12 children, of which 67% were monocytic variants of AML. This article presents the case of a 29-year-old man with AML that relapsed in his testicle without evidence of bone marrow relapse. This patient and the two previously mentioned adults experienced bone marrow relapse within 2 months and died within 7 months of their TR. TR in adult myelogenous leukemia should be considered a harbinger of systemic relapse and suggests a need for aggressive local and systemic therapy.
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Affiliation(s)
- D W Shaffer
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200
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Abstract
A 65-year-old woman with a history of recurrent vaginal intraepithelial neoplasia was found to have small cell carcinoma (SCC). Exfoliative cytology was instrumental in the discovery of each episode of vaginal neoplasia. Thorough examination of the patient established the tumor as being primary to the vagina, and immunohistochemistry confirmed it to be a neuroendocrine SCC. Eleven patients with neuroendocrine SCC of the vagina have been reported previously. Morphologic characteristics and histogenesis are discussed within the context of the embryology and natural history of extrapulmonary-genital SCC. They have been classified in the amine precursor uptake and decarboxylation family of neoplasms. Originally, a neuroectodermal origin was proposed, but derivation now is thought to be from multipotential epithelial stem cells of the genital tract. Neuroendocrine SCC tends to be an aggressive neoplasm with a propensity for early spread. Long-term survival for patients with vaginal SCC has not been documented. Therapeutic decisions regarding SCC from this site have been based on information gained from the treatment of these tumors elsewhere. Combined modality therapy using initial surgery and adjuvant treatment, including systemic chemotherapy and local exposure to radiation, has produced an apparent complete response in our patient.
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Affiliation(s)
- R E Joseph
- Department of Obstetrics and Gynecology, Darnall Army Community Hospital, Fort Hood, Texas
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Shaffer DW, Ching DE, Bindra A, Pearson CE. Establishing a self-perpetuating American Heart Association/Advanced Cardiac Life Support program in West Germany. Mil Med 1991; 156:231-2. [PMID: 2057074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Sudden cardiac death is one of the major health problems in industrialized nations. The American Heart Association-sponsored Basic Life Support and Advanced Cardiac Life Support (ACLS) programs provide consensus training programs geared to teach local persons and health care providers the techniques of CPR and advanced life support, respectively. In April 1988, the staff of the U.S. Army Hospital Berlin conducted an ACLS provider course for German physicians. Fourteen students attended the first course; nine passed, and two did not complete the course. Two more courses have been completed. The enthusiasm expressed by the German physicians led to the nomination of one of the physicians for an associate faculty position, and plans for an instructor course of German physicians are under way.
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Affiliation(s)
- D W Shaffer
- Department of Medicine, U.S. Army Hospital Berlin, Federal Republic of Germany
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