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Virtual reality has emerged as a unique educational modality for medical trainees. However, incorporation of virtual reality curricula into formal training programmes has been limited. We describe a multi-centre effort to develop, implement, and evaluate the efficacy of a virtual reality curriculum for residents participating in paediatric cardiology rotations.
Methods:
A virtual reality software program (“The Stanford Virtual Heart”) was utilised. Users are placed “inside the heart” and explore non-traditional views of cardiac anatomy. Modules for six common congenital heart lesions were developed, including narrative scripts. A prospective case–control study was performed involving three large paediatric residency programmes. From July 2018 to June 2019, trainees participating in an outpatient cardiology rotation completed a 27-question, validated assessment tool. From July 2019 to February 2020, trainees completed the virtual reality curriculum and assessment tool during their cardiology rotation. Qualitative feedback on the virtual reality experience was also gathered. Intervention and control group performances were compared using univariate analyses.
Results:
There were 80 trainees in the control group and 52 in the intervention group. Trainees in the intervention group achieved higher scores on the assessment (20.4 ± 2.9 versus 18.8 ± 3.8 out of 27 questions answered correctly, p = 0.01). Further analysis showed significant improvement in the intervention group for questions specifically testing visuospatial concepts. In total, 100% of users recommended integration of the programme into the residency curriculum.
Conclusions:
Virtual reality is an effective and well-received adjunct to clinical curricula for residents participating in paediatric cardiology rotations. Our results support continued virtual reality use and expansion to include other trainees.
Amongst patients with CHD, the time of transition to adulthood is associated with lapses in care leading to significant morbidity. The purpose of this study was to identify differences in perceptions between parents and teens in regard to transition readiness.
Methods:
Responses were collected from 175 teen–parent pairs via the validated CHD Transition Readiness survey and an information request checklist. The survey was distributed via an electronic tablet at a routine clinic visit.
Results:
Parents reported a perceived knowledge gap of 29.2% (the percentage of survey items in which a parent believes their teen does not know), compared to teens self-reporting an average of 25.9% of survey items in which they feel deficient (p = 0.01). Agreement was lowest for long-term medical needs, physical activities allowed, insurance, and education. In regard to self-management behaviours, agreement between parent and teen was slight to moderate (weighted κ statistic = 0.18 to 0.51). For self-efficacy, agreement ranged from slight to fair (weighted κ = 0.16 to 0.28). Teens were more likely to request information than their parents (79% versus 65% requesting at least one item) particularly in regard to pregnancy/contraception and insurance.
Conclusion:
Parents and teens differ in several key perceptions regarding knowledge, behaviours, and feelings related to the management of heart disease. Specifically, parents perceive a higher knowledge deficit, teens perceive higher self-efficacy, and parents and teens agree that self-management is low.
Although interstage mortality for infants with hypoplastic left heart syndrome has declined within the National Pediatric Cardiology Quality Improvement Collaborative, variation across centres persists. It remains unclear whether centres with lower interstage mortality have lower-risk patients or whether differences in care may explain this variation. We examined previously established risk factors across National Pediatric Cardiology Quality Improvement Collaborative centres with lower and higher interstage mortality rates.
Methods
Lower-mortality centres were defined as those with >25 consecutive interstage survivors. Higher-mortality centres were defined as those with cumulative interstage mortality rates >10%, which is a collaborative historic baseline rate. Baseline risk factors and perioperative characteristics were compared.
Results
Seven lower-mortality centres were identified (n=331 patients) and had an interstage mortality rate of 2.7%, as compared with 13.3% in the four higher-mortality centres (n=173 patients, p<0.0001). Of all baseline risk factors examined, the only factor that differed between the lower- and higher-mortality centres was postnatal diagnosis (18.4 versus 31.8%, p=0.001). In multivariable analysis, there remained a significant mortality difference between the two groups of centres after adjusting for this variable: adjusted mortality rate was 2.8% in lower-mortality centres compared with 12.6% in higher-mortality centres, p=0.003. Secondary analyses identified multiple differences between groups in perioperative practices and other variables.
Conclusions
Variation in interstage mortality rates between these two groups of centres does not appear to be explained by differences in baseline risk factors. Further study is necessary to evaluate variation in care practices to identify targets for improvement efforts.
Most theories of government growth place nearly exclusive attention on real changes in public sector activity. Yet, much nominal post–WWII government spending growth was not in the form of the public sector doing more relative to the general economy (real growth), but in the form of government activities becoming relatively more expensive (cost growth). Baumol's (1967) “cost disease” model is our best guide to understanding cost growth, but over time, Baumol has offered conflicting hypotheses about how cost growth bears on real growth. Using 1947–2012 U.S. data, we test these hypotheses, along with a more novel expectation, by modifying Berry and Lowery's (1987b) econometric models of real growth in public purchases and transfers to consider the influence of government cost growth on real public domestic spending.
In this research we hypothesize that aggregate PAC behavior is conditional in nature. PACs in a specific issue sector donate more to a certain political party's candidates the more that political party controls the legislature. However, the more active the legislature is on a specific set of issues the more people/groups/PACs are mobilized in response to the issue. Thus, a conditional relationship emerges where aggregate PAC donations to a political party are a function of party control, agenda activity, and an interaction of the two. We test this conditional theory using data from the Institute on Money in State Politics database on PAC donations to state legislative candidates divided into issue sectors. Our results provide support for our hypotheses that aggregate PAC donations to a political party's candidates are conditional on the level of agenda activity on the issues that concern the PACs.
Recent work suggests that the most fruitful approach to accounting for variations in interest system diversity of any type lies in understanding variations in interest system density (Lowery, Gray and Fellowes 2005). We build on this insight by examining the sources of variation in the substantive diversity of health interests in the American states, focusing on how the densities of several sub-guilds of health interest organizations vary in their responses to changes in the sizes of the constituencies that give rise to them and variations in the policy and political energy supporting their mobilization. We discuss the concept of interest system diversity in the first section of the paper, highlighting its multiple meanings and the limits of prior research. This is followed by a close empirical examination of 14 sub-guilds of state health interest organizations. We conclude by discussing the inherent difficulties of understanding interest system diversity.
Despite extensive research on political activity on the part of corporations, clear and consistent findings remain elusive. We identify three reasons for this failure. First, most of the empirical literature on corporate political activity simply studies the wrong phenomena by examining political action committees rather than lobbying more generally. Second, the literature studies an excessively narrow sample of organizations that might engage in lobbying, focusing almost always on extremely large corporations, which inevitably attenuates variance on many of the variables hypothesized to influence engagement in political activity. And third, prior work is rarely attentive to the diversity of corporate activities, narrowly conceptualizing vital aspects of the business context that might influence decisions to engage in political activity. Based on this critique, we develop and test new models of corporate political activity, finding that the diversity of the economic context within which firms work and firm size matter a great deal, if in ways somewhat different from those reported in prior work.
We examine how economic change influences the supply of organized interests. Indeed, the economies of states have changed markedly since the turn of the century. State economies have grown, and the relative contributions of different economic sectors have changed. We use the Energy-Stability-Area model of interest system density to assess how these changes – along with changes in the productivity of different economic sectors in terms of generating organized interests – have influenced the size and composition of state interest communities from 1997 to 2007. We find that all three sources of economic change have uniquely contributed, and to a significant degree, to demographic change in state communities of organized interests.
What accounts for the growing cost of government in the US? [Berry, William D., and David Lowery. 1984. “The Growing Cost of Government: A Test of Two Explanations.” Social Science Quarterly 65 (3): 735–749] tested two explanations for why the costs of goods and services in the public sector have increased faster than these costs in the private sector in the US: “Baumol's Disease” [Baumol, William J. 1967. “Macroeconomics of Unbalanced Growth: The Anatomy of Urban Crisis.” The American Economic Review 57 (3): 415–426], which focuses on the need for government to match wage increases in the more productive private sector, and [Buchanan, James M., and Gordon Tullock. 1977. “The Expanding Public Sector: Wagner Squared.” Public Choice 31 (1): 147–150] Bureau Voting explanation, which focuses on the voting power of government employees. Berry and Lowery (1984) tested these two explanations using data for the 1947–1979 period and found strong support for the former but little support for the latter. Decades later, a much longer time-series is now available for empirical analysis. Additionally, the character of both public- and private-sector production and the voting power of public employees have changed in ways that may influence the empirical veracity of the two explanations. For these reasons, we extend the original analysis through 2010 to assess whether Baumol's Disease and Bureau Voting continue to have relevance for understanding government cost growth. We find that Baumol's Disease continues to be the better explanation despite changes in both sectors, although public sector wages are now more closely tied to general private rather than manufacturing wages, suggesting that growing production costs may be serving as an increasingly relevant downward pressure on the scope of real government activity.
Large volumes of data and multiple computing platforms are now universal components of paediatric cardiovascular medicine, but are in a constant state of evolution. Often, multiple sets of related data reside in disconnected “silos”, resulting in clinical, administrative, and research activities that may be duplicative, inefficient, and at times inaccurate. Comprehensive and integrated data solutions are needed to facilitate these activities across congenital heart centres. We describe methodology, key considerations, successful use cases, and lessons learnt in developing an integrated data platform across our congenital heart centre.
Two very different kinds of models—cross-sectional models based on the logic of island biogeography and time series models of density dependence—are used to understand interest system density. While they share much in common, it is not at all clear how results derived from cross-sectional models are to be understood in terms of the temporal focus of the time series approach. Thus, the first purpose of this article is to more thoroughly think through how these two modeling strategies and their empirical findings are related to each other. We empirically assess several theoretical conjectures about the relationship of the two modeling strategies by adding a temporal element to the typical cross-sectional analysis of state interest systems via modeling density dependence pooled across four cross-sections from 1980, 1990, 1997, and 2007. By doing so, we add to the literature on state interest system density by examining how it has changed since 1980. Finally, we discuss the nature of this change and what it implies for the temporal development of state interest communities, the second focus of this analysis.
Larvae of Abagrotis orbis (Grote) (Lepidoptera: Noctuidae) are climbing cutworms and can damage grapevines, Vitis vinifera L. (Vitaceae), in early spring by consuming expanding buds. A sex attractant would be useful for monitoring this insect in commercial vineyards. (Z)-7-Tetradecenyl acetate and (Z)-11-hexadecenyl acetate were found in extracts of female abdominal tips. In multiple field experiments, male A. orbis were captured in traps baited with a combination of these two chemicals but not in traps baited with either chemical alone. Males were trapped from mid-September to early October in south-central Washington and south-central British Columbia. Other noctuid moths (Mamestra configurata Walker, Xestia c-nigrum (L.), and Feltia jaculifera (Guenée)) were also captured in traps baited with the A. orbis pheromone and may complicate the use of this lure to monitor A. orbis. Abagrotis discoidalis (Grote) was captured in traps baited with (Z)-7-tetradecenyl acetate but not in traps baited with the two chemicals together.
How does the demand for lobbying reflected by government policy activity influence the use of lobbying strategies and tactics? The authors examine this question by assessing how the complexity of the policy space affects the political action committee (PAC) system. They hypothesize that the complexity of the policy space indirectly affects the size and activity of the PAC system through its direct effect on interest organization density. The authors test this hypothesis within the health sector using a unique data set that connects individual interest organizations registered to lobby U.S. state legislatures with active PACs in the state. It appears that social, economic, and political measures of policy space complexity influence the size of the lobbying community, which in turn influences the size and activity of the PAC community.
To evaluate calls for a more theoretically generalizable, large-N study of EU interest representation, we adapt the ESA model of interest system density, originally developed to study the interest communities of the American states, to the EU case. We necessarily modify both model and measures in order to account for the unique features of the EU policy process. We test the model with OLS regression using data on the density of different types or guilds (economic and social sectors) of organized interests in the European Union. We use the findings to discuss the viability of inter-system transfers of theories about the politics of interest representation.
We consider the impact of direct democracy on state public policy by examining whether initiatives alter the effects of predictors in models of general state policy liberalism. These analyses are couched in Erikson, Wright, and McIver's (1993) opinion liberalism model of state public policy, as augmented by Gray et al.'s (2004) inclusion of measures of organized interests. After presenting our theoretical expectations, we test the different ways that public opinion, organized interests, and initiatives can interact in the determination of public policy with a variety of models. We find little evidence that initiatives alter the congruence between opinion and policy.
The year 1982 saw the publication of Carol Gilligan's In a Different Voice. In general, Gilligan undertook to establish that differences in the approaches of men and women to moral and social structuring issues are based on a different way of approaching ethical and social issues. She found that males emphasize the autonomy of individuals and an ethos of rights in their approach, whereas females emphasize communitarian values and an ethos of care. Gilligan labeled neither approach as superior. Each provided useful, but different, modes for resolving moral and social issues.
Some legal scholars seized upon Gilligan's work as providing justification for creating new modes for evaluating existing legal rules and creating new rules. These scholars, who are sometimes grouped together under the label of the “cultural feminist school” of jurisprudence, claim that the existing legal construct, which was largely the product of a male-dominated society, is preoccupied with individual autonomy and an ethos of rights. Basing legal rules on communitarian values and an ethos of care would result in the making of dramatically different choices. Unlike Gilligan, cultural feminists often see the ethos of care as superior to the ethos of rights and see the changes that would be wrought in the legal system by application of the ethos of care as improvements on the present state of the law.
The purpose of this article is to test, in the context of redistributive justice, the basic postulate of cultural feminist jurisprudence – that men and women approach major societal issues differently so that were we to listen to [women's] different voice, different choices would be made about legal solutions to social problems.
Despite decades of research, our understanding of how institutional contextsinfluence urban political participation remains muddled. It is argued here thatthis confusion arises from the diversity of competing hypotheses, failures toconceptualize the causal processes underlying these hypotheses thoroughly, andthe use of inadequate controls for rival hypotheses. A more comprehensivespecification of the relationship between metropolitan jurisdictional contextsand two modes of participation is provided. After a presentation of atheoretical framework organizing the many extant hypotheses, these are tested,using survey data collected by the Knight Foundation from 2002 in twenty-fiveurban counties. Contrary to prior work, it is found that the size of localgovernments is positively associated with participation, while governmentalfragmentation diminishes the propensity for political action.
This paper extends previous analyses of industrial policy from a corporatist perspective. We advocate a mid-level measure of group influence; the measure is based upon analysis of newspaper stories. A preliminary exploration of NewsBank data is reported, and several interesting trends in economic development policy are isolated. Business and education are heavily involved in policymaking whereas labor and political parties are not at all involved. On the whole, a meso-corporatist model in which business, state government, and education are partners seems to fit better than a business capture model. Some speculations are offered about this new American form of corporatism and its resemblance to the Japanese case.