Group ramsey theory

AbstractA subset S of a group G is said to be a sum-free set if S ∩ (S + S) = ⊘. Such a set is maximal if for every sum-free set T ⊆ G, we have |T| ⩽ |S|. Here, we generalize this concept, defining a sum-free set S to be locally maximal if for every sum free set T such that S ⊆ T ⊆ G, we have S = T. Properties of locally maximal sum-free sets are studied and the sets are determined (up to isomorphism) for groups of small order

A Resident Morbidity and Mortality Conference Curriculum to Teach Identification of Cognitive Biases, Errors, and Debiasing Strategies

Introduction: The morbidity and mortality (M&M) conference has long been a part of the education of residents of all specialties in the United States, yet its structure is variable across training programs. Recent literature has described the use of M&M as a forum for education in quality improvement methodology; however, a structure focusing on education in cognitive biases and errors has not been previously described in MedEdPORTAL. Methods: This structured M&M conference series called upon resident presenters and peers in the audience to examine cognitive biases and errors involved in specific patient cases. Associated materials included preparatory guidelines provided to faculty advisors and resident presenters, a presentation template used during the introductory session, and a handout used during the discussion portions of presentations. Results: During the 2019–2020 academic year, a total of 24 PGY 2 pediatrics residents presented M&M cases. They identified a mean of 3.7 (SD = 1.9) cognitive biases and/or errors per case and a mean of 1.7 (SD = 0.7) debiasing strategies per case. Peers in the audience were also successful in identifying potential biases and errors at play during presentations. Discussion: We found that through this M&M conference structure, residents were able to demonstrate the ability to identify cognitive errors and biases both within themselves and in peers. This provided an effective forum for the identification and discussion of debiasing strategies, even when the series was forced to transition to a virtual format due to the COVID-19 pandemic

Finding the balance : the attitudes of mental health profes[s]ionals toward borderline personality disorder

Mental health professionals may have less positive attitudes toward clients with a diagnosis of borderline personality disorder (BPD) in comparison to clients with other psychiatric diagnoses. Organisational variables such as collegial support may also impact upon attitudes toward work with clients with BPD. The current research investigated attitudes of New Zealand clinicians toward BPD. Two mini focus groups investigated experiences of clinicians with clients with BPD, with an emphasis on attitudes toward the disorder. The focus groups were analysed using grounded theory. Three major themes emerged: professionalism, cost and value, and deservingness. Focus group results were used in the design of a questionnaire to measure attitudes toward BPD in comparison to schizophrenia. Participants were 235 clinicians who read a vignette about a hypothetical client and responded to attitudinal questions that followed the vignette. Attitudes about the client's presentation, symptom exaggeration, clinician motivation and effectiveness of therapy were assessed. The diagnosis in the vignette was varied between BPD and schizophrenia. A colleague's reaction to the clinician's work was depicted as either positive or negative. Results suggested clinicians held significantly less positive attitudes toward a client with BPD in comparison to a client with schizophrenia (p<0.001). No significant effect for colleague reaction was identified, nor was a significant interaction between diagnosis and colleague reaction found. Contrary to the Contact Hypothesis, amount of contact with clients with BPD or schizophrenia was not related to more positive attitudes toward a hypothetical client with one of these diagnoses. Participants with choice over the type of clients on their caseload showed an association between contact with clients with BPD and positive attitudes toward the hypothetical client with BPD. This was not the case for schizophrenia. The findings of this study may suggest ways to enhance non-pejorative case conceptualisation for clients with different psychiatric diagnoses

Bridging the gap:a review of dose investigations in paediatric investigation plans

Aims In the EU, development of new medicines for children should follow a prospectively agreed paediatric investigation plan (PIP). Finding the right dose for children is crucial but challenging due to the variability of pharmacokinetics across age groups and the limited sample sizes available. We examined strategies adopted in PIPs to support paediatric dosing recommendations to identify common assumptions underlying dose investigations and the attempts planned to verify them in children. Methods We extracted data from 73 PIP opinions recently adopted by the Paediatric Committee of the European Medicines Agency. These opinions represented 79 medicinal development programmes and comprised a total of 97 dose investigation studies. We identified the design of these dose investigation studies, recorded the analyses planned and determined the criteria used to define target doses. Results Most dose investigation studies are clinical trials (83 of 97) that evaluate a single dosing rule. Sample sizes used to investigate dose are highly variable across programmes, with smaller numbers used in younger children (< 2 years). Many studies (40 of 97) do not pre-specify a target dose criterion. Of those that do, most (33 of 57 studies) guide decisions using pharmacokinetic data alone. Conclusions Common assumptions underlying dose investigation strategies include dose proportionality and similar exposure−response relationships in adults and children. Few development programmes pre-specify steps to verify assumptions in children. There is scope for the use of Bayesian methods as a framework for synthesizing existing information to quantify prior uncertainty about assumptions. This process can inform the design of optimal drug development strategies

Nursing in a different world: Remote area nursing as a specialist–generalist practice area

Objective Remote area nurses provide primary health care services to isolated communities across Australia. They manage acute health issues, chronic illness, health promotion and emergency responses. This article discusses why their generalist scope of practice should be formally recognised as a specialist nursing practice area. Design Constructivist grounded theory, using telephone interviews (n = 24) with registered nurses and nurse practitioners. Setting Primary health care clinics, in communities of 150–1500 residents across Australia. Participants A total of 24 nurses participated in this study. Results Nurses\u27 perceived their clinical knowledge and skill as insufficient for the advanced, generalist, scope of practice in the remote context, especially when working alone. Experience in other settings was inadequate preparation for working in remote areas. Knowledge and skill developed on the job, with formal learning, such as nurse practitioner studies, extending the individual nurse\u27s scope of practice to meet the expectations of the role, including health promotion. Conclusion Remote area nursing requires different knowledge and skills from those found in any other nursing practice setting. This study supports the claim that remote area nursing is a specialist–generalist role and presents a compelling case for further examination of the generalist education and support needs of these nurses. Combined with multidisciplinary collaboration, developing clinical knowledge and skill across the primary health care spectrum increased the availability of health resources and subsequently improved access to care for remote communities. Further research is required to articulate the contemporary scope of practice of remote area nurses to differentiate their role from that of nurse practitioners

Assessment Of Need For Trauma Education For Pediatric Residents In The Emergency Department, And Creation Of A Video Module In Response

Presented as a themed oral presentation at 2020 IUSM Education Day.Introduction: Over 200 learners rotate through our pediatric emergency department yearly, and roughly 130 of them are residents in a pediatrics (categorical or combined) residency program. For many of these residents, the pediatric emergency medicine rotation is one of the only opportunities for experience with pediatric trauma resuscitation. Consistently, residents have identified pediatric trauma as an area of discomfort within their practice. Trauma resuscitations in the emergency department are relatively infrequent, and high stakes, so are not ideal opportunities for novice learners. Simulation exists as part of the curriculum, but scheduling challenges make increasing this portion of the curriculum impractical. We sought to further explore resident experience with trauma resuscitation education, and to create a new approach to trauma education that would supplement the existing curriculum. Methods: We distributed 2 different surveys to all pediatric residents on their pediatric emergency medicine rotation: one prior to the start of the rotation, and one after completion. Survey data were collected anonymously and voluntarily, over the course of 1 year. Based on preliminary survey data and informal discussions with residents and education leadership, we conceived of the idea of a video as a novel educational tool to supplement our existing pediatric trauma curriculum. This would be viewed online, asynchronously, circumventing many of the practical challenges associated with increasing simulation or patient care time. We developed a script with an emphasis on a practical approach to running a pediatric trauma resuscitation. Results: Our survey data found that residents started their pediatric emergency medicine rotations with low confidence in leading trauma resuscitation, rating their confidence an average of 25.1 on a visual analog scale (VAS) from 1 to 100. There was a modest improvement after the rotation to 43.7. Anxiety about trauma resuscitation, however, remained high with a rating of 63.2 on a VAS of 1 to 100 before the rotation, and 62.5 after. At the end of their rotations, residents reported that patient care and simulation sessions both contributed a moderate amount (63.2 and 56.5 respectively on a VAS from 1 to 100), while self study only contributed a little (33.1). In response to these data, we created a trauma education video for residents rotating through the pediatric emergency department. The video was filmed in one of our own trauma resuscitation rooms in the Riley Pediatric Emergency Department with our own nurses and Emergency Medicine/Pediatrics residents, with technical support from IU Collaboration Technologies and Classroom Support. Conclusions: Our survey data confirmed the need for improvement in education on pediatric trauma resuscitation. Results suggest residents find that more “hands on” opportunities contribute more to their education, but there remain significant challenges to increasing these opportunities. We are hopeful that the practical emphasis of our pediatric trauma education video will improve the effectiveness over other self-study modalities already in existence. In the coming months, we intend to incorporate the video into the online education modules and investigate its impact on resident confidence and comfort with pediatric trauma resuscitation

Simulation-based Learning Experiences in Stuttering Management Delivered Online: What Do Students, Clinical Educators and Simulated Patients Think?

Speech pathology students are required to demonstrate competency across a range of practice areas. There are, however, limited opportunities for students to access clinical placements in the area of stuttering. Simulation-based learning (SBL) activities have proven to be effective in increasing students’ clinical experience in this area. Due to the COVID-19 pandemic, the delivery of in-person SBL programs was not feasible, resulting in a shift to online provision. The aim of this study was to investigate the perceptions of students, clinical educators and simulated patients who participated in an online adult stuttering SBL experience. Ten first-year graduate entry Masters program speech pathology students participated in the study alongside four clinical educators and four simulated patients. The experience involved two online SBL sessions and one online tutorial via videoconferencing from separate locations. Each participant group engaged in focus group interviews exploring their perceptions of the online SBL activity. Thematic network analysis of the focus group interview data was conducted. Overall interpretation of the data from the perspectives of students, clinical educators and simulated patients revealed an overarching global theme that online SBL offers a positive, comfortable and comparable experience to enable students to build client-centred, clinical and telepractice skills. The positive outcomes of this study suggest that together with in-person clinical experiences, online SBL has an important role in the education of speech pathology students.