Biomedical subjects

Brian Reynolds

Publications and source records attributed to Brian Reynolds.

4 recordsLinked to original sources

PubMed2004

Quantitative validation of a general competency composite assessment evaluation.

OBJECTIVES: The authors sought to modify and validate a composite assessment evaluation process that assesses resident acquisition of the Accreditation Council for Graduate Medical Education (ACGME) general competencies (GCs). METHODS: This study critically analyzed the evaluation process used in a multicenter study (150 emergency medicine resident evaluations) to determine whether the procedure was psychometrically valid. For each GC, principal component analysis (PCA) was used to determine whether certain evaluation items could be eliminated, as well as to determine the magnitude of variability explained by up to three linear combinations or "principal components." The factor proportions (factor loadings) of various eigenvectors were measured to determine the degree of variability (determined by the square of the factor proportion) within a data or item set. The factor proportions essentially measure the length of the eigenvector as determined from a correlation matrix. RESULTS: The first three principal components are reported as factor proportion sum (% of total variability) as follows: patient care 0.91 (83%), medical knowledge 0.87 (76%), practice-based learning and improvement 0.90 (81%), interpersonal and communication skills 0.84 (71%), professionalism 0.74 (55%), and systems-based practice 0.80 (64%). PCA showed that evaluating certain traditional categories such as medical knowledge seemed to capture a single element, whereas professionalism appeared to measure a more complex, multidimensional phenomenon. CONCLUSIONS: By using a structured development process, the authors were able to create valid evaluation items for determining resident acquisition of the ACGME GCs.

Clinical Competence↗

PubMed2003

Soluble reactive phosphorus levels in rainfall, cloud water, throughfall, stemflow, soil waters, stream waters and groundwaters for the Upper River Severn area, Plynlimon, mid Wales.

Soluble reactive phosphorus (SRP) data are presented for rainfall, cloud water, soil waters, stream waters and groundwaters at the Plynlimon catchments in mid Wales to examine the hydrochemical functioning of inorganic phosphorus for an acidic and acid sensitive area characteristic of much of the UK uplands. In general, stream water concentrations are low compared to lowland areas. Average concentrations of SRP in rainfall and cloud water (0.3 and 0.9 microM l(-1), respectively) are higher than in stream water with wider ranges in concentration (0-19.3 and 0-20.9 microM l(-1), respectively). Throughfall and stemflow is enriched in SRP compared to rain and cloud water by a factor of approximately twofold and sixfold, respectively: the average concentrations and ranges are 0.73 and 0-6.61 microM l(-1) for throughfall and 2.12 and 0-18.61 microM l(-1) for stemflow. Soil water SRP concentrations measured in the surface layers of representative areas of podzol and gley soils, are further enriched with respect to inputs. Average concentrations and ranges for the L/F and Oh horizons in the podzols are 3.1 microM l(-1) (range: 0.03-17.2 microM l(-1)) and 0.75 microM l(-1) (range: 0.03-2.64 microM l(-1)), respectively. Correspondingly, the average values and ranges for the L/F and Oh horizons in the gley are 2 microM l(-1) (range: 0.03-16.65 microM l(-1)) and 0.4 microM l(-1) (range: 0.03-8.61 microM l(-1)). SRP concentrations in stream and ground water are lower than in atmospheric inputs and surface soil waters and show marked spatial variability. This variability is linked to three catchment features. (1) For streams draining podzolic soils, most of the SRP is retained by the catchment. For this situation, stream and ground waters have average concentrations of approximately 0.05 microM l(-1) with a range of 0-1.47 microM l(-1). There is no clear stream or groundwater SRP response to felling despite a large release of SRP from felling debris (brash) and the forest floor (L/F horizon) with average post-felling concentrations of 11.02 microM l(-1) (0.40-155.0 microM l(-1)) and 23.60 microM l(-1) (0.26-172.23 microM l(-1)), respectively. (2) For forested catchments with gley soils, stream water SRP concentrations are more variable with, in one case, much higher concentrations than for the podzol counterparts (range in average 0.05-0.46 microM l(-1)). (3) For the streams draining gley soils, felling results in a mixed SRP response. At the local scale (ditch drainage), there is a marked enrichment in SRP concentration (average concentrations increase from 0.05 to 1.31 microM l(-1), with a peak concentration of 4.0 microM l(-1)). This response is consistent with the observed mobilisation of SRP from brash and forest floor material (post-felling mean concentrations of 9.39 and 11.94 microM l(-1), respectively). However, stream water concentrations are an order of magnitude lower than observed in the soil waters implying considerable immobilisation of SRP between the soils and the stream. At the larger catchment scale, no discernable enrichment in SRP is observed following felling. The results are related to input-output budgets and the findings interpreted in terms of the dominant hydrogeochemical processes operative and environmental management issues.

Environmental Monitoring↗

PubMed2003

Nitrogen in rainfall, cloud water, throughfall, stemflow, stream water and groundwater for the Plynlimon catchments of mid-Wales.

An extensive study of acidic and acid sensitive moorland and forested catchments in mid-Wales is used to show the water quality functioning with respect to nitrate and ammonium. For this, long-term records of rainfall, cloud water, throughfall, stemflow and stream water (up to 18 years of weekly data) are combined with shorter duration information on stream water associated with small tributary sources and drainage ditches, ground water from a network of exploratory boreholes and paired control and felled catchments. The ratio of nitrate to ammonium is about one in rainfall, cloud water, throughfall and stemflow but the concentrations are much lower in rainfall (approximately 25 microM l(-1)) than in cloud water (approximately 300 microM l(-1)) while throughfall and stemflow are intermediate (approximately 80 microM l(-1)). Within the streams draining moorland and forested areas, nitrate concentrations are close to the mean value in rainfall while ammonium concentrations are often over an order of magnitude lower in the stream than in rainfall and are typically only about a fifth that of nitrate. With felling, stream water nitrate concentrations increase for podzolic soils but show a variable response for gley soils. For the streams draining forested podzols, the concentrations of nitrate can be up to an order of magnitude higher for the first few years after felling compared to than pre-fell values but in later years, concentrations decline to pre-fell and even lower levels. Felling for the podzolic soils barely leads to any changes in ammonium concentration. For the gley soils, felling results in an order of magnitude increase in nitrate and ammonium for a small drainage ditch, but the pulse barely reaches the main stream channel. Rather, within-catchment and within-stream processes not only take up the nitrate and ammonium fluxes generated, but in the case of nitrate, concentrations with- and post-felling are lower than pre-felling concentrations. Groundwater concentrations of nitrate for the moorland and forested catchments are slightly lower than for the streams while for ammonium the reverse is the case: ammonium concentrations in groundwater are about a tenth those of nitrate. With felling, groundwater nitrate concentrations show sporadic increases. For two boreholes, these increases occur during wet periods when groundwater levels are at their shallowest; for one other borehole, there is a gradual and sustained increase over several years. The results are explained in relation to the dominant hydrogeochemical processes operative.

Environmental Monitoring↗

PubMed2003

General competencies are intrinsic to emergency medicine training: a multicenter study.

OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) has promulgated six areas called General Competencies (GCs) that residency programs are required to evaluate. The authors sought to determine if these domains were an intrinsic part of emergency medicine (EM) residency training by using a global assessment evaluation device. METHODS: This was an observational, multicenter, cross-sectional study that compared GC acquisition between first-, second-, and third-year (EM1, EM2, and EM3) residents. Five postgraduate year (PGY) 1 to PGY 3 allopathic EM programs in Michigan participated. A global assessment form using a 1 through 9 ordinal scale with 86 scoring items was given to program directors for each resident in their programs. Analysis of variance (ANOVA) was used to compare the means between EM1, EM2, and EM3 scores. RESULTS: Five EM programs evaluated 150 residents. The GC scores were as follows: Patient Care: EM1 4.92, EM2 5.79, and EM3 6.40; Medical Knowledge: EM1 4.90, EM2 5.80, and EM3 6.46; Practice-based Learning and Improvement: EM1 4.60, EM2 5.48, and EM3 6.16; Interpersonal and Communication Skills: EM1 4.99, EM2 5.39, and EM3 6.01; Professionalism: EM1 5.43, EM2 5.68, and EM3 6.27; Systems-based Practice: EM1 4.80, EM2 5.48, and EM3 6.21. ANOVA showed statistically significant differences (p < 0.001) for all GCs. CONCLUSIONS: EM residents from several residency programs showed statistically significant progressive acquisition of the ACGME GCs using a global assessment device. This suggests that the GCs may be an intrinsic component in the training of EM residents.

Clinical Competence↗