Implementation of a point-of-care ultrasound skills practicum for hospitalists

Introduction Point-of-care ultrasound is recognized as a safe and valuable diagnostic tool for patient evaluation. Hospitalists are prime candidates for advancing the point-of-care ultrasound field given their crucial role in inpatient medicine. Despite this, there is a notable lack of evidence-based ultrasound training for hospitalists. Most research focuses on diagnostic accuracy rather than the training required to achieve it. This study aims to improve hospitalists' point-of-care ultrasound knowledge and skills through a hands-on skills practicum. Methods Four skill practicums were conducted with pre-course, post-course, and six-month evaluations and knowledge assessments. Results The mean pre- vs. post-course knowledge assessment scores significantly improved, 41.7% vs. 75.9% (SD 16.1% and 12.7%, respectively, p < 0.0001). The mean ultrasound skills confidence ratings on a 10-point Likert scale significantly increased post-course (2.60 ± 1.66 vs. 6.33 ± 1.63, p < 0.0001), but decreased at six months (6.33 ± 1.63 vs. 4.10 ± 2.22, p < 0.0001). The greatest limitations to usage pre-course and at six months were knowledge/skills and lack of machine access. While knowledge/skills decreased from pre-course (82.0%) as compared to six-months (64.3%), lack of machine access increased from pre-course (15.8%) to six-months (28.6%) (p = 0.28). Conclusion Hospitalists agree that point-of-care ultrasound has utility in the diagnostic and therapeutic management of patients, though the lack of training is a significant limitation. Our study demonstrated that a brief skills practicum significantly improves hospitalists’ confidence and knowledge regarding ultrasound image acquisition and interpretation in the short term. Long-term confidence and usage wanes, which appears to be due to the lack of machine access

Are randomised controlled trials positivist? Reviewing the social science and philosophy literature to assess positivist tendencies of trials of social interventions in public health and health services

Background: We have previously proposed that trials of social interventions can be done within a ‘realist’ research paradigm. Critics have countered that such trials are irredeemably positivist and asked us to explain our philosophical position. Methods: We set out to explore what is meant by positivism and whether trials adhere to its tenets (of necessity or in practice) via a narrative literature review of social science and philosophical discussions of positivism, and of the trials literature and three case studies of trials. Results: The philosophical literature described positivism as asserting: 1) the epistemic primacy of sensory information; 2) the requirement that theoretical terms equate with empirical terms; 3) the aim of developing universal laws; and 4) the unity of method between natural and social sciences. Regarding 1), it seems that rather than embodying the epistemic primacy of sensory data, RCTs of social interventions in health embrace an anti-positivist approach aiming to test hypotheses derived deductively from prior theory. Considering 2), while some RCTs of social interventions appear to limit theorization to concepts with empirical analogues, others examine interventions underpinned by theories engaging with mechanisms and contextual contingencies not all of which can be measured. Regarding 3), while some trialists and reviewers in the health field do limit their role to estimating statistical trends as a mechanistic form of generalization, this is not an inevitable feature of RCT-based research. Trials of social interventions can instead aim to generalize at the level of theory which specifies how mechanisms are contingent on context. In terms of 4), while RCTs are used to examine biomedical as well as social interventions in health, RCTs of social interventions are often distinctive in using qualitative analyses of data on participant accounts to examine questions of meaning and agency not pursued in the natural sciences. Conclusion: We conclude that the most appropriate paradigm for RCTs of social interventions is realism not positivism

Identifying Student Discussion in Computer-Mediated Problem Solving Chat

The COMPS project employs computer chat for students working in small groups solving classroom problems. This summer’s project aims to build computer classifiers that could effectively “look over the shoulders” of the students while working, to approximately recognize whether the students are engaging in productive discussion. Research questions are: can we write machine classifiers that can recognize reasoning, agreement, and disagreement in student discussions? Can we achieve this using only a common English vocabulary? Several thousand lines of COMPS transcripts were manually annotated. A topic modelling program was used to determine 10 main topics which appeared in the transcripts and the words in those topics. A Linear Classifier and a Support Vector Machine Classifier used the topic model to predict the annotation of each line of dialogue. To address the common English vocabulary research question, an intersection of many transcripts from different sources was combined with Google word lists and modified to accommodate text-chat conventions. In the normal vocabulary, we found f1 scores of 0.7 and above for reasoning. Using only common vocabulary, the scores were slightly lower. The next step is to train our topic model on a combination of transcripts and apply it to other transcripts from different student discussions

What Does it Take to Make Discovery a Success?: A Survey of Discovery Tool Adoption, Instruction, and Evaluation Among Academic Libraries

Discovery tools have been widely adopted by academic libraries, yet little information exists that connects common practices regarding discovery tool implementation, maintenance, assessment, and staffing with conventions for research and instruction. The authors surveyed heads of reference and instruction departments in research and land-grant university libraries. The survey results revealed common practices with discovery tools among academic libraries. This study also draws connections between operational, instructional, and assessment practices and perceptions that participants have of the success of their discovery tool. Participants who indicated successful implementation of their discovery tool hailed from institutions that made significant commitments to the operations, maintenance, and acceptance of their discovery tool. Participants who indicated an unsuccessful implementation, or who were unsure about the success of their implementation, did not make lasting commitments to the technical maintenance, operations, and acceptance of their discovery tool

Distinguishing suicides of persons reported missing from those not reported missing: a retrospective Scottish cohort study

Background: Understanding what distinguishes the suicide of individuals reported missing (missing-suicides) from those of individuals not reported missing (other-suicides) may have preventative and/or operational utility and inform our knowledge of suicide.Aims: To assess whether specific epidemiological, sociodemographic or circumstantial characteristics differ between individuals reported missing and those not reported missing who take their own life.Method: Content analysis of Scottish Police Death Reports, detailing 160 suicides/undetermined deaths over a 3-year period in the North-East of Scotland.Results:Those in the missing-suicide group were more likely to be older but did not differ from the other-suicide group on any other epidemiological or sociodemographic characteristics. Individuals in the other-suicide group were more likely to be found inadvertently by people known to them. The missing-suicide group took longer to find and were more likely to be located in natural outdoor locations by police/searchers or members of the public.Conclusions: Individuals who die by suicide and who are reported as a missing person differ from those not reported as missing in terms of factors relating to location and how they are found but not epidemiological or sociodemographic characteristics.<br/

Models and measurements of energy-dependent quenching.

Energy-dependent quenching (qE) in photosystem II (PSII) is a pH-dependent response that enables plants to regulate light harvesting in response to rapid fluctuations in light intensity. In this review, we aim to provide a physical picture for understanding the interplay between the triggering of qE by a pH gradient across the thylakoid membrane and subsequent changes in PSII. We discuss how these changes alter the energy transfer network of chlorophyll in the grana membrane and allow it to switch between an unquenched and quenched state. Within this conceptual framework, we describe the biochemical and spectroscopic measurements and models that have been used to understand the mechanism of qE in plants with a focus on measurements of samples that perform qE in response to light. In addition, we address the outstanding questions and challenges in the field. One of the current challenges in gaining a full understanding of qE is the difficulty in simultaneously measuring both the photophysical mechanism of quenching and the physiological state of the thylakoid membrane. We suggest that new experimental and modeling efforts that can monitor the many processes that occur on multiple timescales and length scales will be important for elucidating the quantitative details of the mechanism of qE

Care staff intentions to support adults with an intellectual disability to engage in physical activity: An application of the Theory of Planned Behaviour

Researchers suggest that people with an intellectual disability (ID) undertake less physical activity than the general population and many rely, to some extent, on others to help them to access activities. The Theory of Planned Behaviour (TPB) model was previously found to significantly predict the intention of care staff to facilitate a healthy diet in those they supported. The present study examined whether the TPB was useful in predicting the intentions of 78 Scottish care staff to support people with ID to engage in physical activity. Regression analyses indicated that perceived behavioural control was the most significant predictor of both care staff intention to facilitate physical activity and reported physical activity levels of the people they supported. Attitudes significantly predicted care staff intention to support physical activity, but this intention was not itself significantly predictive of reported activity levels. Increasing carers' sense of control over their ability to support clients' physical activity may be more effective in increasing physical activity than changing their attitudes towards promoting activit

Gender, relationship breakdown, and suicide risk: a review of research in western countries

An association between divorce and suicide risk has been noted in numerous studies, but the gender profile of this risk has not been clearly established. This article reviews the evidence on gender differentials in suicide risk following the breakdown of an intimate relationship (including divorce and separation). Nineteen published articles that included individuallevel data were identified. Twelve reported a greater risk of suicide in men following relationship breakdown, two indicated a greater risk in women, and a further five showed no clear gender differential. Although there are possible indications of increased risk for men, no definitive conclusion about gender differential can be drawn. Furthermore, research is required that directly compares men with women for suicide risk following relationship breakdown