Decreasing the threat to learning: the impact of gender ratio in clinical skills small groups

Background & Objective: Small-group learning is a popular fundamental teaching strategy in undergraduate medical education (UME). Evidence of women acting as “social vaccines” for their women peers in small groups has been described in engineering, but not in UME. We seek to better understand the impact of smallgroup gender composition on medical student learning. Methods: Preclinical medical students were surveyed throughout their clinical skills (CS) course. Likert-scale questions measured students’ perception of their simulation encounters as challenging or threatening, and data were used to calculate a challenge-to-threat ratio (CTR). Scores \u3e1 indicated a situation more challenging than threatening, whilesurvey. Results: Survey response rates ranged from 62.6-78.8%. Average CTRs of firstyear students were higher for men (1.52-1.64, n=62) than women (1.23-1.46, n=71). All CTRs decreased at the start of the second year (0.80-1.40, n=108), but rebounded as student training progressed (1.29-2.36, n=118). Early second-year CS group gender composition did not impact men (similar CTRs ranging 0.83-1.09). However, women reported a disparate CTR across groups with one, two, and three women (0.80, 1.40, and 1.38 , respectively). Late second-year students reported the highest CTRs in groups with gender parity and lowest CTRs in groups with only one female student. Sentiment analysis of open comments shows a gender effect, with more negative sentiments from women. Conclusions: Women were less confident than their male peers in the early CS small-group learning environment. Less confidence for all students was reported as CS cases progressed in the second-year to an internal medicine focus; however, confidence recovered in the late second year. A significant threat was perceived by the sole woman in a small group, but the presence of 1-2 other women appeared to be protective against this effect on confidence.https://jdc.jefferson.edu/sexandgenderhealth/1024/thumbnail.jp

Mental health first aid training in a workplace setting: A randomized controlled trial [ISRCTN13249129]

BACKGROUND: The Mental Health First Aid training course was favorably evaluated in an uncontrolled trial in 2002 showing improvements in participants' mental health literacy, including knowledge, stigmatizing attitudes, confidence and help provided to others. This article reports the first randomized controlled trial of this course. METHODS: Data are reported on 301 participants randomized to either participate immediately in a course or to be wait-listed for 5 months before undertaking the training. The participants were employees in two large government departments in Canberra, Australia, where the courses were conducted during participants' work time. Data were analyzed according to an intention-to-treat approach. RESULTS: The trial found a number of benefits from this training course, including greater confidence in providing help to others, greater likelihood of advising people to seek professional help, improved concordance with health professionals about treatments, and decreased stigmatizing attitudes. An additional unexpected but exciting finding was an improvement in the mental health of the participants themselves. CONCLUSIONS: The Mental Health First Aid training has shown itself to be not only an effective way to improve participants' mental health literacy but also to improve their own mental health. It is a course that has high applicability across the community

Interventions to Improve Vaccination Uptake and Cost Effectiveness of Vaccination Strategies in Newly Arrived Migrants in the EU/EEA: A Systematic Review.

Newly arrived migrants to the EU/EEA (arrival within the past five years), as well as other migrant groups in the region, might be under-immunised and lack documentation of previous vaccinations, putting them at increased risk of vaccine-preventable diseases circulating in Europe. We therefore performed a systematic review conforming to PRISMA guidelines (PROSPERO CRD42016045798) to explore: (i) interventions that improve vaccine uptake among migrants; and (ii) cost-effectiveness of vaccination strategies among this population. We searched MEDLINE, Embase, CINAHL, and Cochrane Database of Systematic Reviews (CDSR) between 1 January 2006 to 18 June 2018. We included three primary intervention studies performed in the EU/EEA or high-income countries and one cost effectiveness study relevant to vaccinations in migrants. Intervention studies showed small but promising impact only on vaccine uptake with social mobilization/community outreach, planned vaccination programs and education campaigns. Targeting migrants for catch-up vaccination is cost effective for presumptive vaccination for diphtheria, tetanus, and polio, and there was no evidence of benefit of carrying out pre-vaccination serological testing. The cost-effectiveness is sensitive to the seroprevalence and adherence to vaccinations of the migrant. We conclude that scarce but direct EU/EEA data suggest social mobilization, vaccine programs, and education campaigns are promising strategies for migrants, but more research is needed. Research should also study cost effectiveness of strategies. Vaccination of migrants should continue to be a public heath priority in EU/EEA

The Universal Real Projective Plane: LHC phenomenology at one Loop

The Real Projective Plane is the lowest dimensional orbifold which, when combined with the usual Minkowski space-time, gives rise to a unique model in six flat dimensions possessing an exact Kaluza Klein (KK) parity as a relic symmetry of the broken six dimensional Lorentz group. As a consequence of this property, any model formulated on this background will include a stable Dark Matter candidate. Loop corrections play a crucial role because they remove mass degeneracy in the tiers of KK modes and induce new couplings which mediate decays. We study the full one loop structure of the corrections by means of counter-terms localised on the two singular points. As an application, the phenomenology of the (2,0) and (0,2) tiers is discussed at the LHC. We identify promising signatures with single and di-lepton, top antitop and 4 tops: in the dilepton channel, present data from CMS and ATLAS may already exclude KK masses up to 250 GeV, while by next year they may cover the whole mass range preferred by WMAP data.Comment: 45 pages, 3 figure

Experiences in applying skills learned in a mental health first aid training course: a qualitative study of participants' stories

BACKGROUND: Given the high prevalence of mental disorders and the comparatively low rate of professional help-seeking, it is useful for members of the public to have some skills in how to assist people developing mental disorders. A Mental Health First Aid course has been developed to provide these skills. Two randomized controlled trials of this course have shown positive effects on participants' knowledge, attitudes and behavior. However, these trials have provided limited data on participants' subsequent experiences in providing first aid. To remedy this, a study was carried out gathering stories from participants in one of the trials, 19–21 months post-training. METHODS: Former course participants were contacted and sent a questionnaire either by post or via the internet. Responses were received from 94 out of the 131 trainees who were contacted. The questionnaire asked about whether the participant had experienced a post-training situation where someone appeared to have a mental health problem and, if so, asked questions about that experience. RESULTS: Post-training experiences were reported by 78% of respondents. Five key points emerged from the qualitative data: (1) the majority of respondents had had some direct experience of a situation where mental health issues were salient and the course enabled them to take steps that led to better effects than otherwise might have been the case; (2) positive effects were experienced in terms of increased empathy and confidence, as well as being better able to handle crises; (3) the positive effects were experienced by a wide range of people with varied expectations and needs; (4) there was no evidence of people over-reaching themselves because of over-confidence and (5) those who attended were able to identify quite specific benefits and many thought the course not only very useful, but were keen to see it repeated and extended. CONCLUSION: The qualitative data confirm that most members of the public who receive Mental Health First Aid training subsequently provide support to people with mental health problems and that this support generally has positive effects

Can postponement of an adverse outcome be used to present risk reductions to a lay audience? A population survey

BACKGROUND: For shared decision making doctors need to communicate the effectiveness of therapies such that patients can understand it and discriminate between small and large effects. Previous research indicates that patients have difficulties in understanding risk measures. This study aimed to test the hypothesis that lay people may be able to discriminate between therapies when their effectiveness is expressed in terms of postponement of an adverse disease event. METHODS: In 2004 a random sample of 1,367 non-institutionalized Danes aged 40+ was interviewed in person. The participants were asked for demographic information and asked to consider a hypothetical preventive drug treatment. The respondents were randomized to the magnitude of treatment effectiveness (heart attack postponement of 1 month, 6 months, 12 months, 2 years, 4 years and 8 years) and subsequently asked whether they would take such a therapy. They were also asked whether they had hypercholesterolemia or had experienced a heart attack. RESULTS: In total 58% of the respondents consented to the hypothetical treatment. The proportions accepting treatment were 39%, 52%, 56%, 64%, 67% and 73% when postponement was 1 month, 6 months, 12 months, 2 years, 4 years and 8 years respectively. Participants who thought that the effectiveness information was difficult to understand, were less likely to consent to therapy (p = 0.004). CONCLUSION: Lay people can discriminate between levels of treatment effectiveness when they are presented in terms of postponement of an adverse event. The results indicate that such postponement is a comprehensible measure of effectiveness

HGF Mediates the Anti-inflammatory Effects of PRP on Injured Tendons

Platelet-rich plasma (PRP) containing hepatocyte growth factor (HGF) and other growth factors are widely used in orthopaedic/sports medicine to repair injured tendons. While PRP treatment is reported to decrease pain in patients with tendon injury, the mechanism of this effect is not clear. Tendon pain is often associated with tendon inflammation, and HGF is known to protect tissues from inflammatory damages. Therefore, we hypothesized that HGF in PRP causes the anti-inflammatory effects. To test this hypothesis, we performed in vitro experiments on rabbit tendon cells and in vivo experiments on a mouse Achilles tendon injury model. We found that addition of PRP or HGF decreased gene expression of COX-1, COX-2, and mPGES-1, induced by the treatment of tendon cells in vitro with IL-1β. Further, the treatment of tendon cell cultures with HGF antibodies reduced the suppressive effects of PRP or HGF on IL-1β-induced COX-1, COX-2, and mPGES-1 gene expressions. Treatment with PRP or HGF almost completely blocked the cellular production of PGE2 and the expression of COX proteins. Finally, injection of PRP or HGF into wounded mouse Achilles tendons in vivo decreased PGE2 production in the tendinous tissues. Injection of platelet-poor plasma (PPP) however, did not reduce PGE2 levels in the wounded tendons, but the injection of HGF antibody inhibited the effects of PRP and HGF. Further, injection of PRP or HGF also decreased COX-1 and COX-2 proteins. These results indicate that PRP exerts anti-inflammatory effects on injured tendons through HGF. This study provides basic scientific evidence to support the use of PRP to treat injured tendons because PRP can reduce inflammation and thereby reduce the associated pain caused by high levels of PGE2. © 2013 Zhang et al

A Dark Matter candidate from Lorentz Invariance in 6 Dimensions

We study the unique 6 dimensional orbifold with chiral fermions where a stable dark matter candidate is present due to Lorentz invariance on the orbifold, with no additional discrete symmetries imposed by hand. We propose a model of Universal Extra Dimensions where a scalar photon of few hundred GeV is a good candidate for dark matter. The spectrum of the model is characteristic of the geometry, and it has clear distinctive features compared to previous models of Kaluza-Klein dark matter. The 5 dimensional limit of this model is the minimal model of natural Kaluza-Klein dark matter. Notwithstanding the low mass range preferred by cosmology, the model will be a challenge for the LHC due to the relatively small splitting between the states in the same KK level.Comment: 37 pages, 6 figure