Comparison of Flex vs. residential clinical education program outcomes: physical therapy students’ self-efficacy, confidence, and clinical competence

Purpose: Alternative flexible (Flex) path Doctor of Physical Therapy (DPT) programs may have an emerging footprint. The differences between Flex and traditional residential DPT program clinical experience outcomes remain unknown. The purpose of this study was to evaluate Flex and residential DPT students’ clinical reasoning self-efficacy, confidence with treating, and Clinical Performance Instrument (CPI) clinical reasoning and summative scores during clinical experiences. Methods: A descriptive and exploratory cross-sectional survey was used with a voluntary convenience sample of 211 university DPT students during Fall 2020 full-time clinical experiences. Descriptive and inferential statistics evaluated differences in Flex and residential DPT program students’ (1) Physical Therapist Self-Efficacy (PTSE) scale scores, (2) confidence with treating initial and subsequent same-patient visits, and (3) final CPI clinical reasoning and summative scores during clinical experiences. Results: Mean PTSE scores were significantly lower for Flex (x̄ = 14.2) compared to residential DPT students (x̄ = 15.2) (P \u3c 0.05). No significant student differences were found in (1) Flex (x̄ = 2.1) and residential (x̄ = 2.2) confidence with treating at the initial visit (P = 0.59), (2) Flex (x̄ = 2.8) and residential (x̄ = 3.0) confidence with treating subsequent same-patient visits (P = 0.15), and (3) Flex (x̄ = 15.8) and residential (x̄ = 16.5) CPI clinical reasoning (P = 0.17), and (4) Flex (x̄ = 16.1) and residential (x̄ = 16.7) CPI summative scores (P = 0.21). Conclusion: Clinical reasoning self-efficacy among Flex DPT students was lower, but there was no difference in CPI clinical reasoning or summative results between Flex and residential DPT students. In the university investigated, the Flex distance learning DPT program curriculum appeared effective in preparing students’ clinical reasoning readiness for the available full-time clinical experiences. We recommend academic institutions consider expanding Flex entry-level DPT program availability options because the outcomes were comparable. Additional flex entry programs may help address the underrepresentation of nontraditional students in entry-level DPT programs and societal demands for physical therapy services

Spitzer Imaging of the Nearby Rich Young Cluster, Cep OB3b

We map the full extent of a rich massive young cluster in the Cep OB3b association with the IRAC and MIPS instruments aboard the {\it Spitzer} Space Telescope and the ACIS instrument aboard the $\it{Chandra}$ X-Ray Observatory. At 700 pc, it is revealed to be the second nearest large ($>1000$ member), young ($< 5$ Myr) cluster known. In contrast to the nearest large cluster, the Orion Nebula Cluster, Cep OB3b is only lightly obscured and is mostly located in a large cavity carved out of the surrounding molecular cloud. Our infrared and X-ray datasets, as well as visible photometry from the literature, are used to take a census of the young stars in Cep OB3b. We find that the young stars within the cluster are concentrated in two sub-clusters; an eastern sub-cluster, near the Cep B molecular clump, and a western sub-cluster, near the Cep F molecular clump. Using our census of young stars, we examine the fraction of young stars with infrared excesses indicative of circumstellar disks. We create a map of the disk fraction throughout the cluster and find that it is spatially variable. Due to these spatial variations, the two sub-clusters exhibit substantially different average disk fractions from each other: $32$ and $50$. We discuss whether the discrepant disk fractions are due to the photodestruction of disks by the high mass members of the cluster or whether they result from differences in the ages of the sub-clusters. We conclude that the discrepant disk fractions are most likely due to differences in the ages.Comment: 48 Pages, 12 figures, 6 table

Hydrogeologic Investigations of Pavement Subsidence in the Cumberland Gap Tunnel

Cumberland Gap Tunnel was constructed under Cumberland Gap National Historical Park in 1996 to improve transportation on a segment of U.S. 25E, connecting Kentucky and Tennessee and restoring Cumberland Gap to its historical appearance. The concrete pavement in the tunnel started to subside in 2001. Ground penetrating radar surveys revealed voids in many areas of the limestone roadbed aggregate beneath the pavement. To investigate possible hydrogeologic processes that may have caused favorable conditions for voids to form in the aggregate, we studied geology, groundwater flow, and groundwater chemistry in the tunnel using a variety of methods, including bore drilling, packer test, dye tracing, groundwater- and surface-flow monitoring, water-chemistry modeling, and an aggregate dissolution experiment. The study revealed that the aggregate receives a large volume of groundwater from much of the bedrock invert, but the flow velocity is too slow to transport small particles out of the aggregate. Calcite saturation indices calculated from water-chemistry data suggest that the groundwater was capable of continuously dissolving calcite, the primary mineral in the limestone aggregate. Water samples taken during different flow conditions indicate that groundwater under low-flow conditions. The dissolution experiment showed that all the limestone aggregate placed beneath the roadbed and in contact with groundwater lost mass; the highest mass loss was 3.4 percent during a 178-day period. The experiment also suggested that water with higher calcite-dissolving potential removed limestone mass quicker than water with low calcite-dissolving potential. We recommend that the limestone aggregate be replaced with noncarbonate aggregate, such as granite, to prevent dissolution and future road subsidence

Incorporando un plan de Vida Saludable en la Terapia Familiar Conductual: Ejemplificando un Caso Clínico de una Mujer con historial de Violencia Doméstica, Negligencia Infantil, Abuso de Drogas y Obesidad

Women reported to child protective service agencies frequently report problems that significantly interfere with the health and well-being of their children and themselves. Behavioral treatment programs appear to be effective in managing these co-existing problems, such as domestic violence and substance abuse. However, evidence-supported interventions are rarely exemplified in complicated clinical cases, especially within child welfare settings. Therefore, in this case example, we describe the process of adapting an evidence-supported treatment to assist in managing significant co-existing health-related problems in a mother who was referred due to child neglect and drug abuse. At the conclusion of therapy, the participant reported improvements in perceived family relationships, illicit drug use, child maltreatment potential, whereas other health-related outcomes were mixed. Most improvements were maintained at 4-month follow-up. Issues relevant to implementing evidence-based treatments within community contexts are discussed, including methods of increasing the likelihood of valid outcome assessment, managing treatment integrity, and adjusting standardized treatments to accommodate co-occurring problems. This research was supported by a grant from the National Institute on Drug Abuse (1R01DA020548-01A1) awarded to Brad Donohue. The authors wish to thank Sally K. Miller, PhD, APN, FAANP and Associate Professor, UNLV School of Nursing for her work in completing the initial in-home health evaluation/physical for the current project.Las mujeres reportadas a las agencias de servicios de protección infantil, con frecuencia presentan problemas que interfieren con la salud y el bienestar de ellas y de sus hijos. Los programas de intervención conductual parecen ser eficaces en el manejo de problemas coexistentes como: la violencia doméstica y el abuso de drogas. Sin embargo, los tratamientos cuya eficacia ya ha sido demostrada en ocasiones anteriores, rara vez se han puesto en práctica en casos clínicos complicados, sobre todo en los centros de asistencia a menores. Por lo tanto, en este caso clínico, se describe el proceso de adaptación de un tratamiento eficaz para ayudar a controlar los problemas coexistentes de salud de una mujer acusada de negligencia infantil y abuso de drogas. Al finalizar el tratamiento, la participante informó sobre la mejoría en sus relaciones familiares, sobre su consumo de drogas y la negligencia infantil; aunque otros resultados relacionados con su salud no quedaron completamente claros. Gran parte de las mejorías se mantuvieron hasta 4 meses  después de haber concluido el tratamiento. Antes de implementar cada fase del tratamiento, discutimos los  contextos de la comunidad, aumentando así la probabilidad de obtener resultados positivos y respetando la integridad y el ajuste del tratamiento estándar para evitar que se presenten problemas en un futuro.Esta investigación se financió gracias a una subvención del Instituto Nacional de Drogodependencia (1R01DA020548-01A1) otorgada a Brad Donohue. Los autores desean agradecer a Sally K. Miller, PhD, APN, FAANP y Profesora Asociada de la Escuela de Enfermería de La Universidad de Nevada Las Vegas, por el examen físico inicial que se llevó a cabo en el domicilio de la participante de este proyecto

Proton Beam Therapy Versus Conformal Photon Radiation Therapy for Childhood Craniopharyngioma: Multi-institutional Analysis of Outcomes, Cyst Dynamics, and Toxicity

PurposeWe compared proton beam therapy (PBT) with intensity modulated radiation therapy (IMRT) for pediatric craniopharyngioma in terms of disease control, cyst dynamics, and toxicity.Methods and MaterialsWe reviewed records from 52 children treated with PBT (n=21) or IMRT (n=31) at 2 institutions from 1996-2012. Endpoints were overall survival (OS), disease control, cyst dynamics, and toxicity.ResultsAt 59.6 months' median follow-up (PBT 33 mo vs IMRT 106 mo; P<.001), the 3-year outcomes were 96% for OS, 95% for nodular failure-free survival and 76% for cystic failure-free survival. Neither OS nor disease control differed between treatment groups (OS P=.742; nodular failure-free survival P=.546; cystic failure-free survival P=.994). During therapy, 40% of patients had cyst growth (20% requiring intervention); immediately after therapy, 17 patients (33%) had cyst growth (transient in 14), more commonly in the IMRT group (42% vs 19% PBT; P=.082); and 27% experienced late cyst growth (32% IMRT, 19% PBT; P=.353), with intervention required in 40%. Toxicity did not differ between groups. On multivariate analysis, cyst growth was related to visual and hypothalamic toxicity (P=.009 and .04, respectively). Patients given radiation as salvage therapy (for recurrence) rather than adjuvant therapy had higher rates of visual and endocrine (P=.017 and .024, respectively) dysfunction.ConclusionsSurvival and disease-control outcomes were equivalent for PBT and IMRT. Cyst growth is common, unpredictable, and should be followed during and after therapy, because it contributes to late toxicity. Delaying radiation therapy until recurrence may result in worse visual and endocrine function

Atmospheric Acetaldehyde: Importance of Air-Sea Exchange and a Missing Source in the Remote Troposphere.

We report airborne measurements of acetaldehyde (CH3CHO) during the first and second deployments of the National Aeronautics and Space Administration (NASA) Atmospheric Tomography Mission (ATom). The budget of CH3CHO is examined using the Community Atmospheric Model with chemistry (CAM-chem), with a newly-developed online air-sea exchange module. The upper limit of the global ocean net emission of CH3CHO is estimated to be 34 Tg a-1 (42 Tg a-1 if considering bubble-mediated transfer), and the ocean impacts on tropospheric CH3CHO are mostly confined to the marine boundary layer. Our analysis suggests that there is an unaccounted CH3CHO source in the remote troposphere and that organic aerosols can only provide a fraction of this missing source. We propose that peroxyacetic acid (PAA) is an ideal indicator of the rapid CH3CHO production in the remote troposphere. The higher-than-expected CH3CHO measurements represent a missing sink of hydroxyl radicals (and halogen radical) in current chemistry-climate models

Platform Dependent Verification: On Engineering Verification Tools for 21st Century

The paper overviews recent developments in platform-dependent explicit-state LTL model checking.Comment: In Proceedings PDMC 2011, arXiv:1111.006

The Effect of Volitional Preemptive Abdominal Contraction on Biomechanical Measures During A Front Versus Back Loaded Barbell Squat

# Background Weightlifting is growing in popularity among recreational and competitive athletes. The barbell back squat (BackS) is commonly included in these training programs, while the barbell front squat (FrontS) is commonly performed as a component of other lifts such as the power clean or clean and jerk, it is less commonly practiced in isolation. # Hypothesis/Purpose The purpose of this study was to examine the effects of VPAC performance on trunk muscle and LE biomechanical responses during loaded BackS versus FrontS in healthy subjects. # Study Design Controlled Laboratory Study # Methods Healthy male subjects with the ability to perform a sub-maximal loaded barbell squat lift were recruited. Subjects completed informed consent, demographic/medical history questionnaires and an instructional video. Subjects practiced VPAC and received feedback. Surface electromyography (sEMG) electrodes and kinematic markers were applied. Muscles included were the internal oblique (IO), external oblique (EO), rectus abdominis, iliocostalis lumborum (ICL), superficial multifidi, rectus femoris, vastus lateralis, biceps femoris, and gluteus maximus. Maximal voluntary isometric contractions established reference sEMG values. A squat one-rep-max (1RM) was predicted by researchers using a three to five repetition maximum (3RM, 5RM) load protocol. Subjects performed BackS trials at 75% 1RM while FrontS trials were performed at 75% BackS weight, both with and without VPAC. Subjects performed three repetitions of each condition with feet positioned on two adjacent force plates. Significant interactions and main effects were tested using a 2(VPAC strategy) x 2(squat variation) and 2(VPAC strategy) x 2(direction) within-subject repeated measures ANOVAs. Tukey's Post-Hoc tests identified the location of significant differences. # Results Trunk muscle activity was significantly higher during FrontS versus BackS regardless of VPAC condition. (IO: p=0.018, EO: p\<0.001, ICL: p\<0.001) VPAC increased performance time for both squat variations (p=.0011), which may be associated with decreased detrimental force potential on the lumbar spine and knees. VPAC led to improved ability to maintain a neutral lumbar spine during both squat variations. This finding is associated with decreased detrimental force potential on the lumbar spine. # Conclusions Findings could help guide practitioners and coaches to choose squat variations and incorporate VPAC strategies during their treatments and/or training programs. # Level of Evidence Level 3 ©The Author(s

History of Anvers-Hugo Trough, western Antarctic Peninsula shelf, since the Last Glacial Maximum. Part I: Deglacial history based on new sedimentological and chronological data

Reconstructing the advance and retreat of past ice sheets provides important long-term context for recent change(s) and enables us to better understand ice sheet responses to forcing mechanisms and external boundary conditions that regulate grounding line retreat. This study applies various radiocarbon dating techniques, guided by a detailed sedimentological analyses, to reconstruct the glacial history of Anvers-Hugo Trough (AHT), one of the largest bathymetric troughs on the western Antarctic Peninsula (WAP) shelf. Existing records from AHT indicate that the expanded Antarctic Peninsula Ice Sheet (APIS) advanced to, or close to, the continental shelf edge during the Last Glacial Maximum (LGM; 23-19 cal kyr BP [ = calibrated kiloyears before present]), with deglaciation of the outer shelf after ∼16.3 cal kyr BP. Our new chronological data show that the APIS had retreated to the middle shelf by ∼15.7 cal kyr BP. Over this 600-year interval, two large grounding-zone wedges (GZW) were deposited across the middle (GZW2) and inner shelf (GZW3), suggesting that their formation occurred on centennial rather than millennial timescales. Expanded sequences of sub-ice shelf sediments occur seaward of the inner GZW3, which suggests that the grounding line remained stationary for a prolonged period over the middle shelf. Grounding-line retreat rates indicate faster retreat across the outer to middle shelf compared to retreat across the middle to inner shelf. We suggest that variable retreat rates relate to the broad-scale morphology of the trough, which is characterised by a relatively smooth, retrograde seabed on the outer to middle shelf and rugged morphology with a locally landward shallowing bed and deep basin on the inner shelf. A slowdown in retreat rate could also have been promoted by convergent ice flow over the inner shelf and the availability of pinning points associated with bathymetric highs around Anvers Island and Hugo Island