Does tailoring instructional style to a medical student\u27s self-perceived learning style improve performance when teaching intravenous catheter placement? A randomized controlled study.

BACKGROUND: Students may have different learning styles. It is unclear, however, whether tailoring instructional methods for a student\u27s preferred learning style improves educational outcomes when teaching procedures. The authors sought to examine whether teaching to a student\u27s self-perceived learning style improved the acquisition of intravenous (IV) catheter placement skills. The authors hypothesized that matching a medical student\u27s preferred learning style with the instructor\u27s teaching style would increase the success of placing an IV catheter. METHODS: Using the VARK model (i.e., visual [V], auditory [A], read/write [R] and kinesthetic [K]), third-year medical students reported their self-perceived learning style and were subsequently randomized to instructors who were trained to teach according to a specific learning format (i.e., visual, auditory). Success was gauged by: 1) the placement of an IV on the first attempt and 2) the number of attempts made until an IV line was successfully placed. RESULTS: The average number of attempts in the matched learning style group was 1.53, compared to 1.64 in the unmatched learning style group; however, results were not statistically significant. Both matched and unmatched groups achieved a similar success rate (57 and 58 %, respectively). Additionally, a comparison of success between the unmatched and matched students within each learning style modality yielded no statistical significance. CONCLUSIONS: Results suggest that providing procedural instruction that is congruent with a student\u27s self-perceived learning style does not appear to improve outcomes when instructing students on IV catheter placement

The Cloud Nucleating Properties and Mixing State of Marine Aerosols Sampled along the Southern California Coast

Marine aerosols are a globally significant contributor to aerosol-cloud-climate interactions; however, the impact that different sources of pollution and natural emissions from the ocean have on the water uptake properties of marine aerosols remains largely underexplored. Here we present measurements of the cloud condensation nuclei (CCN) activation of marine aerosols taken in a coastal, marine environment impacted by sea spray aerosol and different sources of pollution. The hygroscopicity parameter, κ, was found to range from <0.1 up to 1.4 with a campaign-average value of 0.22 ± 0.12. Smaller particles were less hygroscopic than larger ones, and κ varied diurnally and temporally as a function of air mass transport conditions. Measurements made using aerosol time-of-flight mass spectrometry (ATOFMS) revealed that heterogeneous reactions, sulfates, and temporal differences in the observed particle types had the largest impacts on the observed κ values. The aerosol mixing-state was also found to affect κ. Temporal differences between freshly-emitted soot and aged soot internally mixed with sulfates, likely emitted from ships, had the largest impact on diurnal variations in κ. Our results further demonstrate the significant impact that pollution and the aerosol mixing-state have on aerosol-cloud interactions in the marine boundary layer

Predictors of hospital-associated complications prolonging ICU stay in patients with low-grade aneurysmal subarachnoid hemorrhage

OBJECTIVEThe authors sought to determine the predictors of late neurological and hospital-acquired medical complications (HACs) in patients with low-grade aneurysmal subarachnoid hemorrhage (aSAH).METHODSThe authors conducted a retrospective study of 424 patients with low-grade aSAH admitted to their institution from 2008 to 2015. Data collected included patient comorbidities, Hunt and Hess (HH) grade, ICU length of stay (LOS), and complications. A logistic regression analysis was performed to determine the predictors for neurological and hospital-associated complications.RESULTSOut of 424 patients, 50 (11.8%) developed neurological complications after the first week, with a mean ICU stay of 16.3 ± 6.5 days. Of the remaining 374 patients without late neurological complications, 83 (22.2%) developed late HACs with a mean LOS of 15.1 ± 7.6 days, while those without medical complications stayed 11.8 ± 6.2 days (p = 0.001). Of the 83 patients, 55 (66.3%) did not have any HACs in the first week. Smoking (p = 0.062), history of cardiac disease (p = 0.043), HH grade III (p = 0.012), intraventricular hemorrhage (IVH) (p = 0.012), external ventricular drain (EVD) placement (p = 0.002), and early pneumonia/urinary tract infection (UTI)/deep vein thrombosis (DVT) (p = 0.001) were independently associated with late HACs. Logistic regression showed early pneumonia/UTI/DVT (p = 0.026) and increased HH grade (p = 0.057) to be significant risk factors for late medical complications.CONCLUSIONSWhile an extended ICU admission allows closer monitoring, low-grade aSAH patients develop HACs despite being at low risk for neurological complications. The characteristics of low-grade aSAH patients who would benefit from early discharge are reported in detail

Risk of Venous Thromboembolism in Patients with Large Hemispheric Infarction Undergoing Decompressive Hemicraniectomy

Deep-venous thrombosis (DVT) and pulmonary embolism (PE) are major causes of morbidity and mortality in patients with acute ischemic stroke. This study is the first to examine the risk of venous thromboembolism in patients with large hemispheric infarction undergoing decompressive hemicraniectomy. The study population included 95 consecutive patients with a large hemispheric infarction who underwent decompressive hemicraniectomy between 2006 and 2014 at our institution. All patients received prophylactic unfractionated heparin and intermittent compression devices (SCD). Patients were systematically screened for DVT at 5-day interval using Duplex ultrasound. PE was diagnosed on chest CT angiography. Mean age was 57 ± 12 years; mean BMI was 28.3 ± 7.4 kg/m(2). 30.5 % of patients had infarction in the dominant hemisphere and 69.5 % in the non-dominant hemisphere. The mean NIHSS score was 16.0 ± 5 at admission. The mean length of stay was 22 ± 17 days. 35 % of patients developed a DVT including 27 % who developed above-knee DVT and required placement of an inferior vena cava filter. In multivariable analysis, predictors of DVT were an NIHSS ≥ 17 (p = 0.007), seizures (p = 0.003), hypertension (p = 0.03), and increasing length of stay (p = 0.01). The proportion of patients who developed PE was 13 %. In multivariate analysis, BMI ≥ 30 predicted PE (p = 0.05). The rate of DVT and PE is remarkably high in patients with large hemispheric infarction undergoing decompressive hemicraniectomy despite prophylactic measures. We recommend routine screening for DVT in this population. Interventions beyond the standard prophylactic measures may be necessary in this high-risk group