Implementation of an Ultraviolet Phototherapy Service at a National Referral Hospital in Western Kenya: Reflections on Challenges and Lessons Learned.

IntroductionIn order to manage skin conditions at a national referral hospital level in Kenya, specialized dermatology services, such as dermatologic surgery, dermatopathology, phototherapy, and sub-specialty care, should be offered, as is typically available in referral hospitals around the world. A Kenyan patient with prurigo nodularis, whose severe itch remitted after phototherapy treatment at the University of California, San Francisco (UCSF), inspired the development of a phototherapy service at Academic Model Providing Access to Healthcare (AMPATH), a partnership in Western Kenya between Moi Teaching and Referral Hospital, Moi University College of Health Sciences, and a consortium of North American academic medical centers.MethodsInitial project funds were raised through a crowdfunding campaign and fundraising events. A new narrowband ultraviolet B phototherapy unit and replacement bulbs were donated and air shipped to Eldoret, Kenya. A team of dermatologists and phototherapy nurses from UCSF conducted a 2-day training session. US-based dermatologists affiliated with AMPATH provide ongoing support through regular communication and on-site visits.ResultsEarly in implementation, challenges faced included training clinical staff with limited experience in phototherapy and improving communication between nurses and clinicians. More recent challenges include frequent rotation of specialty clinic nurses in the dermatology clinic, adaptation of phototherapy guidelines to balance patient volume with service delivery capacity, and training assessment of disease activity in darkly pigmented skin.ConclusionStrategies that have been helpful in addressing implementation challenges include: increasing on-site and remote training opportunities for clinicians and nurses, developing a tiered payment schema, educating patients to combat misconceptions about phototherapy, dynamic phototherapy referral guidelines to accommodate service delivery capacity, and prioritizing the engagement of a multidisciplinary team

Psychology students’ perception of and engagement with feedback as a function of year of study

Undergraduate students’ perception of feedback and level of engagement with the feedback they receive have gained increasing attention in the educational literature recently to identify areas which require educators’ attention. However, research in this area has generally been based on limited self-selecting samples, and has not considered how students’ relationship with feedback may alter depending on their year of study. To address this, a survey measuring students’ views and practices regarding feedback was completed at a higher education institution by 447 first-, second- and third-year psychology students, representing 77% of the cohort. Findings revealed that third years responded more negatively in both areas than their first- and second-year counterparts, whose ratings on these aspects themselves were far from optimal. These findings highlight the need for early interventions to improve students’ perception of and engagement with feedback in the earlier years, and to prevent the recorded deterioration later on in the degree course

Spatial Modeling of Common Raven Density and Occurrence Helps Guide Landscape Management Within Great Basin Sagebrush Ecosystems

Common ravens (Corvus corax; ravens) are a behaviorally flexible nest predator of several avian species, including species of conservation concern. Movement patterns based on life history phases, particularly territoriality of breeding birds and transiency of nonbreeding birds, are thought to influence the frequency and efficacy of nest predation. As such, predicting where on the landscape territorial resident and non-territorial transient birds may be found in relation to the distribution of sensitive prey is of increasing importance to managers and conservationists. From 2007 to 2019, we conducted raven point count surveys between mid-March and mid-September across 43 different field sites representing typical sagebrush (Artemisia spp.) ecosystems of the Great Basin, USA. The surveys conducted during 2007–2016 were used in previously published maps of raven occurrence and density. Here, we examined the relationship between occurrence and density of ravens using spatially explicit predictions from 2 previously published studies and differentiate areas occupied by higher concentrations of resident ravens as opposed to transients. Surveys conducted during 2017–2019 were subsequently used to evaluate the predicted trends from our analytical approach. Specifically, we used residuals from a generalized linear regression to establish the relationship between occurrence and density, which ultimately resulted in a spatially explicit categorical map that identifies areas of resident versus transient ravens. We evaluated mapped categories using independently collected observed raven group sizes from the 2017–2019 survey data, as well as an independent dataset of global positioning system locations of resident and transient individuals monitored during 2019–2020. We observed moderate agreement between the mapped categories and independent datasets for both evaluation approaches. Our map provides broad inference about spatial variation in potential predation risk from ravens for species such as greater sage-grouse (Centrocercus urophasianus) and can be used as a valuable spatial layer for decision support tools aimed at guiding raven management decisions and, ultimately, improving survival and reproduction of sensitive prey within the Great Basin

SMaRT: A Science-based Tiered Framework for Common Ravens

Large-scale increases and expansion of common raven (Corvus corax; raven) populations are occurring across much of North America, leading to increased negative consequences for livestock and agriculture, human health and safety, and sensitive species conservation. We describe a science-based adaptive management framework that incorporates recent quantitative analyses and mapping products for addressing areas with elevated raven numbers and minimizing potential adverse impacts to sensitive species, agricultural damage, and human safety. The framework comprises 5 steps: (1) desktop analysis; (2) field assessments; (3) comparison of raven density estimates to an ecological threshold (in terms of either density or density plus distance to nearest active or previous nest); (4) prescribing management options using a 3-tiered process (i.e., habitat improvements, subsidy reductions, and direct actions using StallPOPd.V4 software); and (5) post-management monitoring. The framework is integrated within the Science-based Management of Ravens Tool (SMaRT), a web-based application outfitted with a user-friendly interface that guides managers through each step to develop a fully customized adaptive plan for raven management. In the SMaRT interface, users can: (1) interact with pre-loaded maps of raven occurrence and density and define their own areas of interest within the Great Basin to delineate proposed survey or treatment sites; (2) enter site-level density estimates from distance sampling methods or perform estimation of raven densities using the rapid assessment protocol that we provide; (3) compare site-level density estimates to an identified ecological threshold; and (4) produce a list of potential management options for their consideration. The SMaRT supports decision-making by operationalizing scientific products for raven management and facilitates realization of diverse management goals including sensitive species conservation, protection of livestock and agriculture, safeguarding human health, and addressing raven overabundance and expansion. We illustrate the use of the framework through SMaRT using an example of greater sage-grouse (Centrocercus urophasianus) conservation efforts within the Great Basin, USA

Cassini observations of ionospheric plasma in Saturn's magnetotail lobes

Studies of Saturn's magnetosphere with the Cassini mission have established the importance of Enceladus as the dominant mass source for Saturn's magnetosphere. It is well known that the ionosphere is an important mass source at Earth during periods of intense geomagnetic activity but lesser attention has been dedicated to study the ionospheric mass source at Saturn. In this paper we describe a case study of data from Saturn's magnetotail, when Cassini was located at ∼2200 hours Saturn local time at 36 RS from Saturn. During several entries into the magnetotail lobe, tailward-flowing cold electrons and a cold ion beam were observed directly adjacent to the plasma sheet and extending deeper into the lobe. The electrons and ions appear to be dispersed, dropping to lower energies with time. The composition of both the plasma sheet and lobe ions show very low fluxes (sometimes zero within measurement error) of water group ions. The magnetic field has a swept-forward configuration which is atypical for this region and the total magnetic field strength larger than expected at this distance from the planet. Ultraviolet auroral observations show a dawn brightening and upstream heliospheric models suggest that the magnetosphere is being compressed by a region of high solar wind ram pressure. We interpret this event as the observation of ionospheric outflow in Saturn's magnetotail. We estimate a number flux between 2.95±0.43×109 1.43±0.21×1010 cm-2 s-1, one or about two orders magnitude larger than suggested by steady state MHD models, with a mass source between 1.4×102 and 1.1×103 kg/s. After considering several configurations for the active atmospheric regions, we consider as most probable the main auroral oval, with associated mass source between 49.7±13.4 and 239.8±64.8 kg/s for an average auroral oval, and 10±4 and 49±23 kg/s for the specific auroral oval morphology found during this event. It is not clear how much of this mass is trapped within the magnetosphere and how much is lost to the solar wind

Foveal contour interaction on the edge: Response to 'Letter-to-the-Editor' by Drs. Coates and Levi

Recently, we reported that, when considered as a function of the edge-to-edge target-toflanker separation in min arc, the spatial extent of foveal contour interaction is the same for high and low contrast acuity targets. This result resolved an apparent discrepancy in the literature, which suggested that foveal contour interaction was absent or reduced for low contrast targets. In commenting on our results, Drs. Coates and Levi suggest a two-mechanism model for foveal crowding that depends on the center-to-center separation between the acuity target and flanking stimuli, and is based in part on a reanalysis of data from our recent work and a number of other studies. In our reply, we show that the spatial extent of foveal contour interaction for both high and low contrast targets is essentially unchanged by the width of the flanking targets when the target-to-flanker separation is depicted in terms of edge-to-edge separation, but varies systematically when depicted in terms of center-to-center separation. We therefore conclude that for foveal contour interaction in the range of a few min arc, edge-to-edge target-to-flanker separation is the more appropriate metric

Dealing with the difficult student in emergency medicine

Dealing with a student who is perceived as difficult to work with or teach is inevitable in any academic physician's career. This paper will outline the basic categories of these difficulties pertinent to Emergency Medicine rotations in order to facilitate appropriate identification of problems. Strategies for evaluation and reporting of the difficult student are presented. Remediation, based on the type of difficulty, is addressed. Timeliness of reporting, evaluation, and feedback are invaluable to allow for appropriate assessment of the outcome of the remediation plan

Seagrasses in the Age of Sea Turtle Conservation and Shark Overfishing

Efforts to conserve globally declining herbivorous green sea turtles have resulted in promising growth of some populations. These trends could significantly impact critical ecosystem services provided by seagrass meadows on which turtles feed. Expanding turtle populations could improve seagrass ecosystem health by removing seagrass biomass and preventing of the formation of sediment anoxia. However, overfishing of large sharks, the primary green turtle predators, could facilitate turtle populations growing beyond historical sizes and trigger detrimental ecosystem impacts mirroring those on land when top predators were extirpated. Experimental data from multiple ocean basins suggest that increasing turtle populations can negatively impact seagrasses, including triggering virtual ecosystem collapse. Impacts of large turtle populations on seagrasses are reduced in the presence of intact shark populations. Healthy populations of sharks and turtles, therefore, are likely vital to restoring or maintaining seagrass ecosystem structure, function, and their value in supporting fisheries and as a carbon sink

Seeing the way: visual sociology and the distance runner's perspective

Employing visual and autoethnographic data from a two‐year research project on distance runners, this article seeks to examine the activity of seeing in relation to the activity of distance running. One of its methodological aims is to develop the linkage between visual and autoethnographic data in combining an observation‐based narrative and sociological analysis with photographs. This combination aims to convey to the reader not only some of the specific subcultural knowledge and particular ways of seeing, but also something of the runner's embodied feelings and experience of momentum en route. Via the combination of narrative and photographs we seek a more effective way of communicating just how distance runners see and experience their training terrain. The importance of subjecting mundane everyday practices to detailed sociological analysis has been highlighted by many sociologists, including those of an ethnomethodological perspective. Indeed, without the competence of social actors in accomplishing these mundane, routine understandings and practices, it is argued, there would in fact be no social order