The How and Why of Preparing Graduate Students to Carry out Participatory Research

Participatory research or self-directed education. . .In both cases, learners become the responsible decision-makers about values and priorities

Contextualizing the relevance of basic sciences: small-group simulation with debrief for first- and second-year medical students in an integrated curriculum.

There has been a call for increased integration of basic and clinical sciences during preclinical years of undergraduate medical education. Despite the recognition that clinical simulation is an effective pedagogical tool, little has been reported on its use to demonstrate the relevance of basic science principles to the practice of clinical medicine. We hypothesized that simulation with an integrated science and clinical debrief used with early learners would illustrate the importance of basic science principles in clinical diagnosis and management of patients.Small groups of first- and second-year medical students were engaged in a high-fidelity simulation followed by a comprehensive debrief facilitated by a basic scientist and clinician. Surveys including anchored and open-ended questions were distributed at the conclusion of each experience.The majority of the students agreed that simulation followed by an integrated debrief illustrated the clinical relevance of basic sciences (mean ± standard deviation: 93.8% ± 2.9% of first-year medical students; 96.7% ± 3.5% of second-year medical students) and its importance in patient care (92.8% of first-year medical students; 90.4% of second-year medical students). In a thematic analysis of open-ended responses, students felt that these experiences provided opportunities for direct application of scientific knowledge to diagnosis and treatment, improving student knowledge, simulating real-world experience, and developing clinical reasoning, all of which specifically helped them understand the clinical relevance of basic sciences.Small-group simulation followed by a debrief that integrates basic and clinical sciences is an effective means of demonstrating the relationship between scientific fundamentals and patient care for early learners. As more medical schools embrace integrated curricula and seek opportunities for integration, our model is a novel approach that can be utilized

The Narcotic Bowel Syndrome: Clinical Features, Pathophysiology, and Management

Narcotic bowel syndrome (NBS) is a subset of opioid bowel dysfunction that is characterized by chronic or frequently recurring abdominal pain that worsens with continued or escalating dosages of narcotics. This syndrome is under recognized and may be becoming more prevalent. This may be due in the United States to increases in using narcotics for chronic non-malignant painful disorders, and the development of maladaptive therapeutic interactions around its use. NBS can occur in patients with no prior gastrointestinal disorder who receive high dosages of narcotics after surgery or acute painful problems, among patients with functional GI disorders or other chronic gastrointestinal diseases who are managed by physicians unaware of the hyperalgesic effects of chronic opioids. The evidence for the enhanced pain perception is based on: a) activation of excitatory anti-analgesic pathways within a bimodal opioid regulation system, b) descending facilitation of pain at the Rostral Ventral Medulla and pain facilitation via dynorphin and CCK activation, and c) glial cell activation that produces morphine tolerance and enhances opioid induced pain. Treatment involves early recognition of the syndrome, an effective physician patient relationship, graded withdrawal of the narcotic according to a specified withdrawal program and the institution of medications to reduce withdrawal effects

Discovery of a rich proto-cluster at z=2.9 and associated diffuse cold gas in the VIMOS Ultra-Deep Survey (VUDS)

[Abridged] We characterise a massive proto-cluster at z=2.895 that we found in the COSMOS field using the spectroscopic sample of the VIMOS Ultra-Deep Survey (VUDS). This is one of the rare structures at z~3 not identified around AGNs or radio galaxies, so it is an ideal laboratory to study galaxy formation in dense environments. The structure comprises 12 galaxies with secure spectroscopic redshift in an area of 7'x8', in a z bin of Dz=0.016. The measured galaxy number overdensity is delta_g=12+/-2. This overdensity has total mass of M~8.1x10^(14)M_sun in a volume of 13x15x17 Mpc^3. Simulations indicate that such an overdensity at z~2.9 is a proto-cluster that will collapse in a cluster of total mass M~2.5x10^(15)M_sun at z=0. We compare the properties of the galaxies within the overdensity with a control sample at the same z but outside the overdensity. We did not find any statistically significant difference between the properties (stellar mass, SFR, sSFR, NUV-r, r-K) of the galaxies inside and outside the overdensity. The stacked spectrum of galaxies in the overdensity background shows a significant absorption feature at the wavelength of Lya redshifted at z=2.895 (lambda=4736 A), with a rest frame EW = 4+/- 1.4 A. Stacking only background galaxies without intervening sources at z~2.9 along their line of sight, we find that this absorption feature has a rest frame EW of 10.8+/-3.7 A, with a detection S/N of ~4. These EW values imply a high column density (N(HI)~3-20x10^(19)cm^(-2)), consistent with a scenario where such absorption is due to intervening cold gas streams, falling into the halo potential wells of the proto-cluster galaxies. However, we cannot exclude the hypothesis that this absorption is due to the diffuse gas within the overdensity.Comment: 15 pages, 9 figures, accepted for publication in A&A (revised version after referee's comments and language editing

Web of the giant: Spectroscopic confirmation of a large-scale structure around the z = 6.31 quasar SDSS J1030+0524

We report on the spectroscopic confirmation of a large-scale structure around the luminous z = 6.31 quasi-stellar object (QSO) SDSS J1030+0524, powered by a one billion solar mass black hole. The structure is populated by at least six members, namely, four Lyman-break galaxies (LBGs), and two Lyman alpha emitters (LAEs). The four LBGs were identified among a sample of 21 i-band dropouts with zAB < 25.5 selected up to projected separations of 5 physical Mpc (15 arcmin) from the QSO. Their redshifts were determined through multi-object spectroscopic observations at 8-10 m class telescopes lasting up to eight hours. The two LAEs were identified in a 6 h VLT/MUSE observation centered on the QSO. The redshifts of the six galaxies cover the range between 6.129-6.355. Assuming that the peculiar velocities are negligible, this range corresponds to radial separations of \ub15 physical Mpc from the QSO, that is comparable to the projected scale of the observed LBG distribution on the sky. We conservatively estimate that this structure is significant at a level > 3.5\u3c3 and that the level of the galaxy overdensity is at least 1.5-2 within the large volume sampled ( 3c780 physical Mpc3). The spectral properties of the six member galaxies (Ly\u3b1 strength and UV luminosity) are similar to those of field galaxies at similar redshifts. This is the first spectroscopic identification of a galaxy overdensity around a supermassive black hole in the first billion years of the Universe. Our finding lends support to the idea that the most distant and massive black holes form and grow within massive (>1012 M) dark matter halos in large-scale structures and that the absence of earlier detections of such systems is likely due to observational limitations

The VIMOS Ultra Deep Survey First Data Release: spectra and spectroscopic redshifts of 698 objects up to z~6 in CANDELS

This paper describes the first data release (DR1) of the VIMOS Ultra Deep Survey (VUDS). The DR1 includes all low-resolution spectroscopic data obtained in 276.9 arcmin2 of the CANDELS-COSMOS and CANDELS-ECFDS survey areas, including accurate spectroscopic redshifts z_spec and individual spectra obtained with VIMOS on the ESO-VLT. A total of 698 objects have a measured redshift, with 677 galaxies, two type-I AGN and a small number of 19 contaminating stars. The targets of the spectroscopic survey are selected primarily on the basis of their photometric redshifts to ensure a broad population coverage. About 500 galaxies have z_spec>2, 48 with z_spec>4, and the highest reliable redshifts reach beyond z_spec=6. This dataset approximately doubles the number of galaxies with spectroscopic redshifts at z>3 in these fields. We discuss the general properties of the sample in terms of the spectroscopic redshift distribution, the distribution of Lyman-alpha equivalent widths, and physical properties including stellar masses M_star and star formation rates (SFR) derived from spectral energy distribution fitting with the knowledge of z_spec. We highlight the properties of the most massive star-forming galaxies, noting the large range in spectral properties, with Lyman-alpha in emission or in absorption, and in imaging properties with compact, multi-component or pair morphologies. We present the catalogue database and data products. All data are publicly available and can be retrieved from a dedicated query-based database available at http://cesam.lam.fr/vuds.Comment: 11 pages, 6 figures, submitted to A&

The Lyman Continuum escape fraction of galaxies at z=3.3 in the VUDS-LBC/COSMOS field

The Lyman continuum (LyC) flux escaping from high-z galaxies into the IGM is a fundamental quantity to understand the physical processes involved in the reionization epoch. We have investigated a sample of star-forming galaxies at z~3.3 in order to search for possible detections of LyC photons escaping from galaxy halos. UV deep imaging in the COSMOS field obtained with the prime focus camera LBC at the LBT telescope was used together with a catalog of spectroscopic redshifts obtained by the VIMOS Ultra Deep Survey (VUDS) to build a sample of 45 galaxies at z~3.3 with L>0.5L*. We obtained deep LBC images of galaxies with spectroscopic redshifts in the interval 3.27<z<3.40 both in the R and deep U bands. A sub-sample of 10 galaxies apparently shows escape fractions>28% but a detailed analysis of their properties reveals that, with the exception of two marginal detections (S/N~2) in the U band, all the other 8 galaxies are most likely contaminated by the UV flux of low-z interlopers located close to the high-z targets. The average escape fraction derived from the stacking of the cleaned sample was constrained to fesc_rel<2%. The implied HI photo-ionization rate is a factor two lower than that needed to keep the IGM ionized at z~3, as observed in the Lyman forest of high-z QSO spectra or by the proximity effect. These results support a scenario where high redshift, relatively bright (L>0.5L*) star-forming galaxies alone are unable to sustain the level of ionization observed in the cosmic IGM at z~3. Star-forming galaxies at higher redshift and at fainter luminosities (L<<L*) can be the major contributors to the reionization of the Universe only if their physical properties are subject to rapid changes from z~3 to z~6-10. Alternatively, ionizing sources could be discovered looking for fainter sources among the AGN population at high-z.Comment: 21 pages, 9 figures. Accepted for publication in A&

A Description of the Integration of Interprofessional Collaborative Practice Competencies in the First 100 Weeks of Medical Student Education.

Background and Introduction: The practice of medicine, the delivery of health care, and medical school curricula have evolved significantly over the past 100 years. Current societal expectations are that our health care systems offer safe, evidence-based, patient-centered care, provided by cohesive, interprofessional teams within systems that limit error, ensure quality, and maximize benefits. The need to transform medical education to include interprofessional educational opportunities that ensure health professionals learn to work collaboratively is well recognized. The basic sciences and medical knowledge must be integrated with clinical practice. The four newly created goals for medical education include standardization of learning outcomes and individualization of the learning process, integration of formal knowledge and clinical experience, development of habits of inquiry and innovation, and focus on professional identity formation. In the development of our new Hofstra North Shore School of Medicine’s (HSOM) curricula, these goals were considered and are evident throughout the interprofessional educational experiences. Purpose: We describe our first efforts, as a new medical school, to design and implement an Interprofessional Education Collaborative (IPEC)-centered curricular experience to ensure they are embedded early and often throughout the first 100 weeks. We use a deliberate practice approach to prepare our students for the interprofessional teams they will join as part of their clinical clerkships and acting internships in the second 100 weeks. Analysis: We reassessed the HSOM core competencies, educational program objectives (EPOs), and individual course learning objectives (LOs) to determine if any curricular gaps in the IPEC core competencies were exposed. We focused particular attention on those courses that have already been conducted during the first 2 years of our school’s existence. Conclusion: Interprofessional educational experiences are woven throughout the first 100 weeks of the HSOM curriculum. As the architects of a new medical school, the deans, administration, and faculty of the HSOM embraced the imperative to reform our contemporary models for health professions education

Phase stability in fMRI time series: Effect of noise regression, off-resonance correction and spatial filtering techniques

Although the majority of fMRI studies exploit magnitude changes only, there is an increasing interest regarding the potential additive information conveyed by the phase signal. This integrated part of the complex number furnished by the MR scanners can also be used for exploring direct detection of neuronal activity and for thermography. Few studies have explicitly addressed the issue of the available signal stability in the context of phase time-series, and therefore we explored the spatial pattern of frequency specific phase fluctuations, and evaluated the effect of physiological noise components (heart beat and respiration) on the phase signal. Three categories of retrospective noise reduction techniques were explored and the temporal signal stability was evaluated in terms of a physiologic noise model, for seven fMRI measurement protocols in eight healthy subjects at 3 T, for segmented CSF, gray and white matter voxels. We confirmed that for most processing methods, an efficient use of the phase information is hampered by the fact that noise from physiological and instrumental sources contributes significantly more to the phase than to the magnitude instability. Noise regression based on the phase evolution of the central k-space point, RETROICOR, or an orthonormalized combination of these were able to reduce their impact, but without bringing phase stability down to levels expected from the magnitude signal. Similar results were obtained after targeted removal of scan-to-scan variations in the bulk magnetic field by the dynamic off-resonance in k-space (DORK) method and by the temporal off-resonance alignment of single-echo time series technique (TOAST). We found that spatial high-pass filtering was necessary, and in vivo a Gaussian filter width of 20 mm was sufficient to suppress physiological noise and bring the phase fluctuations to magnitude levels. Stronger filters brought the fluctuations down to levels dictated by thermal noise contributions, and for 62.5 mm3 voxels the phase stability was as low as 5 mrad (0.27°). In conditions of low SNRo and high temporal sampling rate (short TR); we achieved an upper bound for the phase instabilities at 0.0017 ppm, which is close to the dHb contribution to the GM/WM phase contrast