Happy Holidays

This is the final post of this year, and all I wish to do is to wish all of you a happy holiday break and a very happy new year.

I know the last week has been filled with national news of horror and despair, news which has hurt us all so very much, but there is always wonderment in the world, as this little, gentle, youtube clip shows: http://www.youtube.com/watch?v=PN-MjUC4f9k

Have a wonderful and restful break. See you in 2013.

Elements of Online Course Design

As education develops, the use of online teaching platforms is growing, and it is possible that some of us may have opportunity to test these waters in the future, notably if you work in the area of continuing professional education. People no longer wish to travel and give up precious work time, so the use of online teaching for CE has grown. But the technology also needs to take into account the differences that exist with regard to learning online versus in a classroom or clinical setting. Here are just a few of the notable differences. This information comes from an excellent but slender book by Vai and Sosulski (1).

Absence of a physical teaching space- you are not in a classroom anymore and thus the way you interact with a student is radically altered.

Planning and creating online class content- you need to work out your course material well in advance since much of it is to be posted in some fashion (as text, or a podcast, or youtube clip,etc0>

Communicating online as opposed to in person- this is a key consideration. You no longer have the ability to immediately answer a student’s question simply because they raised their hand. Your affect is lost, students cannot see you body language or facial language, etc. Much of your communication is likely going to occur via email or from communication via posting boards.

Delayed feedback- you cannot be available 24 hours per day, 7 days per week. You need to write with clarity so as to not complicate understanding, you should anticipate questions, you should clearly articulate goals and assignments, etc.

Visual design- you need to give thought about how you depict content on a webpage, you need to account for different browsers, operating systems and computers, and you need to understand the basics of web design as it relates to learning.

Flexibility- online education has elements of flexibility that classroom teaching does not, so as a result deadlines, for example, become important.

Time online- this is something people need to become accustomed to. You will spend lots of time in front of a computer.

Class participation- this is also important. Directions regarding the need to spend time online and offline should be given, as well as for how and how often to post responses to questions.

Office hours- you can use technologies such as Skype to hold actual office hours, or provide instructions online as to how you can be reached.

There are new and novel challenges to taking advantage of this medium, but it is certainly going to become more common in the future.

References

1.       Vai M, Sosulski K. Essentials of online course design: a standards-based approach. New York, NY; Routledge, 2011

 

Three New Papers from Biomed Central Journals

Schafer LM, Hsu C, Eaves ER, Ritenbaugh C, Turner J, Cherkin DC, Sims C, Sherman J. Complementary and alternative medicine (CAM) providers' views of chronic low back pain patients' expectations of CAM therapies: a qualitative study. BMC Compl Altern Med 2012, 12:234 doi:10.1186/1472-6882-12-234

ABSTRACT

Background: Some researchers think that patients with higher expectations for CAM therapies experience better outcomes and that enthusiastic providers can enhance treatment outcomes. This is in contrast to evidence suggesting conventional medical providers often reorient patient expectations to better match what providers believe to be realistic. However, there is a paucity of research on CAM providers' views of their patients' expectations regarding CAM therapy and the role of these expectations in patient outcomes.

Methods: To better understand how CAM providers view and respond to their patients' expectations of a particular therapy, we conducted 32 semi-structured, qualitative interviews with acupuncturists, chiropractors, massage therapists and yoga instructors identified through convenience sampling. Interviews were recorded, transcribed and analyzed thematically using Atlas ti version 6.1.

Results: CAM providers reported that they attempt to ensure that their patients' expectations are realistic. Providers indicated they manage their patients' expectations in a number of domains--- roles and responsibilities of providers and patients, treatment outcomes, timeframe for improvement, and treatment experience. Providers reported that patients' expectations change over time and that they need to continually manage these expectations to enhance patient engagement and satisfaction with treatment.

Conclusions: Providers of four types of CAM therapies viewed patients' expectations as an important component of their experiences with CAM therapy and indicated that they try to align patient expectations with reality. These findings suggest that CAM providers are similar in this respect to conventional medical providers.

Byszewski A, Hendelman W, Mcguinty C, Moineua G. Wanted: role models - medical students' perceptions of professionalism. BMC Med Educ 2012, 12:115 doi:10.1186/1472-6920-12-115

ABSTRACT

Background: Transformation of medical students to become medical professionals is a core competency required for physicians in the 21st century. Role modeling was traditionally the key method of transmitting this skill. Medical schools are developing medial curricula which are explicit in ensuring students develop the professional competency and understand the values and attributes of this role.The purpose of this study was to determine student perception of Professionalism at the University of Ottawa and gain insights for improvement in promotion of professionalism in undergraduate medical education.

Methods: Survey on student perception of professionalism in general, the curriculum and learning environment at the University of Ottawa, and the perception of student behaviors, was developed by faculty and students and sent electronically to all University of Ottawa medical students. The survey included both quantitative items including an adapted Pritzker list and qualitative responses to eight open ended questions on professionalism at the University of Ottawa. All analyses were performed using SAS version 9.1 (SAS Institute Inc. Cary, NC, USA). Chi-square and Fischer's exact test (for cell count less than 5) were used to derive p-values for categorical variables by level of student learning.

Results: Response rate was 45.6% (255 of 559 students) for all four years of the curriculum. 63% of the responses were from students in years 1 and 2 (pre-clerkship). Students identified role modeling as the single most important aspect of professionalism. The strongest curricular recommendations included faculty-led case scenario sessions, enhancing inter-professional interactions and the creation of special awards to staff and students to "celebrate" professionalism. Current evaluation systems were considered least effective. The importance of role modeling and information how to report lapses and breaches was highlighted in the answers to the open ended questions.

Conclusions: Students identify the need for strong positive role models in their learning environment, and for effective evaluation of the professionalism of students and teachers. Medical school leaders must facilitate development of these components within the MD education and faculty development programs as well as in clinical milieus where student learning occurs.

Davis MA, Mackenzie TA, Coulter ID, Whedon JM, Weeks WB. The United States Chiropractic Workforce: An alternative or complement to primary care? Chiropr Man Ther 2012, 20:35 doi:10.1186/2045-709X-20-35

ABSTRACT

Background: In the United States (US) a shortage of primary care physicians has become evident. Other health care providers such as chiropractors might help address some of the nation's primary care needs simply by being located in areas of lesser primary care resources. Therefore, the purpose of this study was to examine the distribution of the chiropractic workforce across the country and compare it to that of primary care physicians.

Methods: We used nationally representative data to estimate the per 100,000 capita supply of chiropractors and primary care physicians according to the 306 predefined Hospital Referral Regions. Multiple variable Poisson regression was used to examine the influence of population characteristics on the supply of both practitioner-types.

Results: According to these data, there are 74,623 US chiropractors and the per capita supply of chiropractors varies more than 10-fold across the nation. Chiropractors practice in areas with greater supply of primary care physicians (Pearson's correlation 0.17, p-value < 0.001) and appear to be more responsive to market conditions (i.e. more heavily influenced by population characteristics) in regards to practice location than primary care physicians.

Conclusion: These findings suggest that chiropractors practice in areas of greater primary care physician supply. Therefore chiropractors may be functioning in more complementary roles to primary care as opposed to an alternative point of access.

 

Password Safety

A November 7 article by Nicole Perlroth  in the New York Times (http://www.nytimes.com/2012/11/08/technology/personaltech/how-to-devise-passwords-that-drive-hackers-away.html?pagewanted=all) provides a bit of a scarifying amount of information about how easy it is these days to obtain passwords used to access private information on the internet. Every day we are bombarded with emails that come from addresses that look suspiciously like someone we know and trust, and often we get emails that seem benign but contain attachments that we may slip and open. All it takes is one lapse of attention and you can lose your password protection to sites where such information is sold for about $20 a pop. And you may not be aware that there are programs specifically designed to crack passwords- a notable one is known as John the Ripper. My guess is that you have likely chose a relatively simple password that you can easily remember, and you use that same password as a gateway to more than one protected site. This makes it likely that at some point in your life you will get hacked. I have, and it’s a pain- I had to change my aol account password as a result, and I had to cancel a credit card, take care of the bills that had been improperly charged to it, and ensure that my credit was not affected.

Ms. Perlroth suggests you use the following strategies for finding new passwords.

Forget the dictionary: don’t use any word that someone could find in a dictionary, since that is often what is first tested by hackers. Don’t even use words where you just change a letter or two. I can tell you that my passwords use a combination of random letters, numbers and grammatical signifiers such as exclamation points.

Don’t use the same password twice: obviously. If a hacker finds it, they get access to all your accounts.

Come up with a passphrase: not a word. Make your passphrase 14 letters or longer, since this added complexity makes it harder to crack. And use one that you will remember, like a phrase from a movie or book.

Randomize: you could just hit the keyboard randomly, throwing in the shift and alt keys as well, and then store the password on an encrypted text file that you put on a flash drive so it is not on your main computer.

Store the password securely: get it off your main computer, and get it onto a flash drive (see above). And do not let the computer store this information so it automatically will enter the information as you log in; some hackers use keystroke logging software to follow your keystrokes.

Consider a password manager: there are password protection software that can store your information in one place. An example is LastPass

Ignore the security questions: because some of this information (i.e. what high school did you go to?) can be easily found on the net. Consider using an answer that makes no sense, i.e. if asked what your favorite color is, you could provide the answer “what is your favorite movie?”

Use different browsers: use several browsers for different activities. This would let you use the second browser to shut down bad activity arising on the first. Studies have shown that Chrome is the browser least often attacked.

These are all good ideas we should consider. Safety first, always!

Thanksgiving

This week is our Thanskgiving break. And while it can never be said enough, I am thankful for all that each one of you do here for this college.

Thanks to the library staff for doing such a great job in meeting our students, faculty and others' needs.

Thanks to the CTL staff for making sure everything runs well both technologically and admninistratively.

Thanks to the faculty for their constant work on updating information, use of novel and innovative teaching methods and technologies and their willingness to always go above and beyond.

Thanks to the administration for their leadership and willingness to trust people to do what's right for the college.

Thanks to the staff for being the moto that keeps this place running.

I hope that you all enjoy this short break, are able to spend time with family ond loved ones, and be careful out there, don't eat too much!

Late Spring Cleaning in Fall

Perhaps one of the things that comes with age is a sense of proportion and pragmatic reality. I recently began a bit of a reconsideration of my life, and it led me, to all things, to do a bit of spring cleaning, here in the middle of the fall. By which I mean, I finally understood I no longer needed to hold on to all the chiropractic journals, medical journals, and ephemera I had built up over the years.

In part, this is was simply a function of space. I have, or had, copies of virtually every issue of every chiropractic and CAM journal published over the past 3 decades, and I no longer had any place to put them. This reminded me of the old article in the Journal of Irreproducible Results which demonstrated that if you put every issue of National Geographic magazine into a single room, you would tilt the Earth off its axis. I held those journals because (1) for so long, I was editor for many of them (JMPT, Journal of Chiropractic Medicine, Chiropractic Technique, Journal of Chiropractic Humanities, Journal of Sports Chiropractic and Rehabilitation, etc.) and (2) because you never know when you might need that one article in the hundreds you have.

But I had to finally admit to myself that the world had changed. The days of a Dr. Henderson holding 18,000 articles in his office file cabinets is gone. Everything is electronic now, and every article I had a hard copy of was available on the web in some fashion, all there for the finding. I asked my students how many subscribe to any of the journals, and the answer was, none- and why should they since we have site licenses for them all. I tried to give the journals away, but there were no takers. So, they are being recycled. And from that, there are old textbooks that could go, and other magazines, and so on. I say this as well knowing good friends who lost the choice when Hurricane Sandy hit; flooding ruined their collection as well and they had to discard all the damaged journals, and it really did not bother them either.

And in the end, with my changing interests- now toward bioethics and evidence-based practice, for example, not technique and orthopedics- I really no longer need them anyway. And it feels sort of good, to be sure.

New NIH Rules on Conflict of Interest

The NIH has issued new policies related to Financial Conflict of Interest. As part of these policies, Palmer College now requires that all faculty conducting research must complete an initial financial conflict of interest screening form annually. This should be submitted with each new research/IRB application. I am taking the following information directly from the NIH website (http://grants.nih.gov/grants/policy/coi/coi_faqs.htm), wherein the new requirements are described more fully.

A. General Questions

1.      What is the purpose of this regulation? (Institution and Investigator)

The 2011 revised regulation promotes objectivity in research by establishing standards that provide a reasonable expectation that the design, conduct, and reporting of research performed under NIH grants or cooperative agreements will be free from bias resulting from Investigator financial conflicts of interest. This regulation is commonly referred to as the Financial Conflict of Interest (FCOI) regulation. (http://www.gpo.gov/fdsys/pkg/FR-2011-08-25/pdf/2011-21633.pdf).

2.      When are Institutions required to comply with the 2011 revised regulation? (Institution)

An Institution applying for or receiving NIH funding from a grant or cooperative agreement must be in compliance with all of the revised regulatory requirements no later than 365 days after publication of the regulation in the Federal Register, i.e., August 24, 2012, and immediately upon making the Institution’s Financial Conflict of Interest policy publicly accessible as described in 42 CFR part 50.604(a).

3.      How does an Institution signify compliance with the 2011 revised regulation? (Institution)

When the Institution posts its Financial Conflict of Interest policy (or, if the institution does not have a current presence on a publicly accessible Web site, makes the policy publicly accessible by written request), it signifies that the Institution applying for or receiving PHS funding from a grant or cooperative agreement that is covered by the 2011 revised regulation is in full compliance with all the regulatory requirements. The Institution must be in compliance with the 2011 revised regulation no later than August 24, 2012.

4.      Is the 2011 revised regulation retroactive? (Institution)

No. The revised regulation will apply to each grant or cooperative agreement with an issue date of the Notice of Award that is subsequent to the compliance dates of the Final Rule (including noncompeting continuations) no later than August 24, 2012 and immediately upon making its Financial Conflict of Interest policy publicly accessible. Through their policies, however, Institutions may choose to apply the revised regulations to all active PHS awards. For example, Institutions may choose, in their Financial Conflict of Interest policy, to implement the regulation on a single date for all PHS-funded awards rather than implementing the regulation sequentially on the specific award date of each individual project.

5.      What is the most significant difference between the 1995 regulation and the 2011 revised regulation? (Institution and Investigator)

The 2011 revised regulation includes comprehensive changes, focusing on these areas in particular:

§  Definition of Significant Financial Interest

§  Extent of Investigators’ disclosure of information to Institutions regarding their Significant Financial Interests;

§  Institutions’ management of identified Financial Conflicts of Interest

§  Information reported to the PHS funding component (e.g., NIH);

§  Information made accessible to the public (i.e., Institutional FCOI policy and FCOIs of senior/key personnel); and

§  Investigator training.

6.      Where can I find additional information? (Institution and Investigator)

More information specific to grants and cooperative agreements is available on the Financial Conflict of Interest Web Page of the Grants Policy and Guidance section of the NIH Office of Extramural Research home page (http://grants.nih.gov/grants/policy/coi/index.htm.)

7.      May an Institution have conflict of interest policies that go beyond the regulation (e.g., impose more stringent requirements than those in the regulation)? (Institution and Investigator)

Yes, as long as the Institution’s policies meet the minimum requirements of the PHS regulation. The regulation states the Institution’s policy must inform each Investigator of the Institution’s policy on Financial Conflict of Interest; of the Investigator's Significant Financial Interest disclosure responsibilities; and of the PHS regulation. If an Institution adopts a policy that includes more restrictive disclosure thresholds than those in the 2011 revised regulation, the Institution must adhere to the requirements of the policy’s more restrictive standards. Institutions must report all identified FCOIs to the NIH, including any financial conflicts of interest identified in accordance with the Institution’s own more restrictive standards, in the time and manner specified in the regulation (see “Reporting” section for additional information).

8.      I have heard there is a special requirement for clinical research. Is this true? (Institution and Investigator)

Yes. In any case in which the HHS determines that an NIH-funded project of clinical research whose purpose is to evaluate the safety or effectiveness of a drug, medical device, or treatment has been designed, conducted, or reported by an Investigator with a conflicting interest that was not managed or reported by the Institution as required by the regulation, the Institution must require the Investigator(s) involved to disclose the Financial Conflict of Interest in each public presentation of the results of the research and to request an addendum to previously published presentations. Institution’s Financial Conflict of Interest policy may have additional requirements.

9.      For how long must Institutions keep records of financial disclosures and any resulting actions under the Institution’s policy or following a retrospective review, if applicable? (Institution)

Institutional policies must be followed regarding maintenance of records as long as they are in compliance with the PHS regulation. Under the regulation, the Institution is required to keep all records of all Investigator disclosures of financial interests and the Institution’s review of, or response to, such disclosure (whether or not a disclosure resulted in the Institution’s determination of a Financial Conflict of Interest), and all actions under the Institution’s policy or retrospective review, if applicable, as follows:

§  Records of financial disclosures and any resulting action must be maintained by the Institution for at least three years from the date of submission of the final expenditures report or, where applicable, from other dates specified in 45 C.F.R. 74.53(b) and 92.42 (b) for different situations.

NIH expects Institutions to retain records for each competitive segment as provided in the regulation.

10.  What is the purpose of this regulation? (Institution and Investigator)

The 2011 revised regulation promotes objectivity in research by establishing standards that provide a reasonable expectation that the design, conduct, and reporting of research performed under NIH grants or cooperative agreements will be free from bias resulting from Investigator financial conflicts of interest. This regulation is commonly referred to as the Financial Conflict of Interest (FCOI) regulation. (http://www.gpo.gov/fdsys/pkg/FR-2011-08-25/pdf/2011-21633.pdf).

 

ASBH 2012

I just returned from attending the annual conference for ASBH, and was once again impressed with the scope of the conference, the dedication of the speakers and even the small amount of chiropracticc representation there (My colleague Stu Kinsinger from CMCC had a poster accepted for presentation. Just to give you an idea of how wide-ranged bioethics si, here are some of the sessions I attended.

• Establishing a Research Ethics Consultation Service: Core Features and Tailored Approaches

• Attitudes Toward Professionalism Among First-Year Medical Students: Bridging the Generation Gap as a Challenge in Professional Education

• Professionalism Endangered: Critical Reflections on Work, Relationships, and Responsibility in Science Production

• Representing Bioethics and Freedom of Speech

• Responsible Stewardship: The Role of National Commissions in Shaping the Public Discourse of Bioethics

• Black Swans, Zebras, and the Strangeness of the Everyday” Low-Probability Events in Biomedicine

• How “Representative” are Institutional Review Boards?

• The Ethics of Research in the Global Health Environment

• Observational Research in Medically Indigent Hospice Patients: A New Tuskegee?

• Bioethics Representation in Today’s Media: The Trouble with Sounds Bites

• Ethics and Healthcare Administrators in Popular Culture

• Social Media and Medicine: (Mis)Representing Physicians and Patients Online

• The Want Ads: Representation, Ethics, and the Presentation of Foster Children

• The Wild West of Incidental Findings

• Moral Science: Protecting Participants in Human Subject Research

• Medicine’s Favorite Doctor: “Oslermania,” Bioethics and the Medical Humanities

• A Genealogy of Persistent Vegetative State

• Who Speaks for Whom? Representation, the Medical Humanities, and the Social Context of Health

• Forced Ethics: From Old Moral Theory to New Moral Reality

• Evidence-Based Medicine: Representation or Misrepresentation of Medicine?

• Patients, Practitioners, and Conscience: A Fresh Approach to Representing  Moral Pluralism in Medicine

• Moral Panic, Moral Monsters and Justice in Health Care

• Social Justice, Health Inequalities, and Methodological Individualism in US Health Promotion

• The Duty to Buy Health Insurance

• Organizational Ethics: Speaking the Wrong Language or Lost in Translation

 

End of Term Youtube Extravaganza Redux

As each term comes to an end, I like to provide you a bit of fun and relief from the stresses of regular work. Here are some fun youtube clips to enjoy (apologies for any bad comments located in the "comment" section, which may change over time and can be rather profane).

1.       Human-Powered Free-Running Machine: Some people have way too much time on their hands: http://www.youtube.com/watch?v=4MiYtvbK4JY&feature=g-logo-xit

2.       Insane Dodge-Ball Kill: it is pretty impressive, I have to say: http://www.youtube.com/watch?v=4MiYtvbK4JY&feature=g-logo-xit

3.       Babies Tasting lemons for the First Time- I’m sorry, this is just funny. http://www.youtube.com/watch?v=CumIj-NH5RA&feature=g-logo-xit

4.       Mythbusters, Coke and Mentos: See what happens. I love these guys (and Kari Byron): http://www.youtube.com/watch?v=LjbJELjLgZg

5.       The Hillary Step, Mount Everest: No way, man. No way! http://www.youtube.com/watch?v=pKq-3H04SkQ

6.       Girl’s State Meet 4x800 race, 2009: This is 10 minutes long but the last 2 minutes are worth it all to watch Stephanie Brown come from nearly 300m behind:
http://www.youtube.com/watch?v=Ge141jaPhNg

7.       Highlights of the 2012 Tour De France: The best race in the world, with the fittest athletes ever. http://www.youtube.com/watch?v=UkIwB5r_sd4&feature=related

8.       Adelle: Rolling in the Deep. Not my usual cup of tea, but what a voice. http://www.youtube.com/watch?v=rYEDA3JcQqw

9.       Clara Does Ballet- this is a viral video that is incredibly touching. Clara, the 10-year-old girl here, has DiGeorge’s Syndrome, but here dances Coppelia nearly perfectly.

http://www.youtube.com/watch?v=0dUcI8mA5hs

10.   Goodbye until next term: http://www.youtube.com/watch?v=8xiWw5dwngc

A Few Keyboard Shortcuts in Windows (From Microsoft: http://support.microsoft.com/kb/126449)

Windows system key combinations

·         F1: Help

·         CTRL+ESC: Open Start menu

·         ALT+TAB: Switch between open programs

·         ALT+F4: Quit program

·         SHIFT+DELETE: Delete item permanently

·         Windows Logo+L: Lock the computer (without using CTRL+ALT+DELETE)

Windows program key combinations

·         CTRL+C: Copy

·         CTRL+X: Cut

·         CTRL+V: Paste

·         CTRL+Z: Undo

·         CTRL+B: Bold

·         CTRL+U: Underline

·         CTRL+I: Italic

Mouse click/keyboard modifier combinations for shell objects

·         SHIFT+right click: Displays a shortcut menu containing alternative commands

·         SHIFT+double click: Runs the alternate default command (the second item on the menu)

·         ALT+double click: Displays properties

·         SHIFT+DELETE: Deletes an item immediately without placing it in the Recycle Bin

General keyboard-only commands

·         F1: Starts Windows Help

·         F10: Activates menu bar options

·         SHIFT+F10 Opens a shortcut menu for the selected item (this is the same as right-clicking an object

·         CTRL+ESC: Opens the Start menu (use the ARROW keys to select an item)

·         CTRL+ESC or ESC: Selects the Start button (press TAB to select the taskbar, or press SHIFT+F10 for a context menu)

·         CTRL+SHIFT+ESC: Opens Windows Task Manager

·         ALT+DOWN ARROW: Opens a drop-down list box

·         ALT+TAB: Switch to another running program (hold down the ALT key and then press the TAB key to view the task-switching window)

·         SHIFT: Press and hold down the SHIFT key while you insert a CD-ROM to bypass the automatic-run feature

·         ALT+SPACE: Displays the main window's System menu (from the System menu, you can restore, move, resize, minimize, maximize, or close the window)

·         ALT+- (ALT+hyphen): Displays the Multiple Document Interface (MDI) child window's System menu (from the MDI child window's System menu, you can restore, move, resize, minimize, maximize, or close the child window)

·         CTRL+TAB: Switch to the next child window of a Multiple Document Interface (MDI) program

·         ALT+underlined letter in menu: Opens the menu

·         ALT+F4: Closes the current window

·         CTRL+F4: Closes the current Multiple Document Interface (MDI) window

·         ALT+F6: Switch between multiple windows in the same program (for example, when the Notepad Find dialog box is displayed, ALT+F6 switches between the Find dialog box and the main Notepad window)