Aum, She Who is Most Auspicious

Light seekers. Familial secrets. And parentified children. AUM, SHE WHO IS MOST AUSPICIOUS is a coming-of-age screenplay about what it means to care for others – and for our selves. On the morning she expects to leave for Europe to pursue music studies, 17-year-old Elise Lichten wakes to find her plane ticket gone – and her mother, too. It’s not the first time. As daughter to guru-seeking Paula, Elise and her sister Lily are used to their mother’s spiritual malaise and unannounced retreats at ashrams overseas. Elise is beyond ready to be free of her family. She has to find a place for her little sister to stay till their mother returns. At first, 17-year-old Gavin Cahill’s adoration for Elise comes with a family – a stable family – for Elise to entrust her sister. But when she begins to warm to his affections, she opens to a world she’s adamantly rejected: one of spiritual devotion, non-duality and an assuredness in the divine. Soon, she loses sight of her dream to study music and finds a new dream in Gavin. But their love comes at a cost: their relationship reveals long-hidden family secrets. When Paula returns, distant and vulnerable, Elise has to decide what she cares for most – and what she’s willing to lose in order to stand unapologetically in who she is. Combining research in storytelling, feminine psychology, and archetypes and mythology, AUM is a heroine’s journey about a young girl’s descent to the underworld and auspicious return

Eligibility for Minimally Invasive Coronary Artery Bypass Examination of Epicardial Adipose Tissue Using Computed Tomography

Objective: A variable that necessitates conversion to a conventional full-sternotomy coronary artery bypass procedure from a robotic-assisted endoscopic single-vessel small thoracotomy is the inability to visualize the left anterior descending coronary artery within the surrounding epicardial adipose tissue using the endoscopic camera. The purpose of this study was to determine whether anatomical properties of the epicardial adipose tissue examined using preoperative computed tomography (CT) images are able to predict and thus reduce the need for intraoperative conversion based on effective preoperative exclusion criteria. Methods: Retrospective analysis of patient preoperative CT angiography scans from both converted (n = 17) and successful robotic-assisted (n = 17) procedures was performed. Where possible, measurements of epicardial adipose tissue were acquired from axial slices, at the most accessible segment of the left anterior descending coronary artery. Results: Results indicate that patients who successfully underwent the endoscopic single-vessel small thoracotomy procedure (mean +/- SD depth, 4.9 +/- 1.9 mm) had significantly less epicardial adipose tissue (38%, P = 0.002) overlying the vessel toward the lateral chest wall than those who were converted to the full-sternotomy approach intraoperatively (mean +/- SD depth, 7.9 +/- 3.2 mm). Using this as a retrospective exclusion criterion reduces the conversion rate for this group by 47%, while maintaining a high specificity (94%). No significant differences exist between the two groups with respect to the remaining epicardial adipose tissue measurements or body mass index. Conclusions: The addition of CT angiography measurements of the epicardial adipose tissue overlying the left anterior descending coronary artery may enhance preoperative surgical planning for this procedure, thereby reducing the instances of procedural changes

Medical Student POCUS Peer-to-Peer Teaching: Ready for Mainstream

Background: Point of care ultrasound (POCUS) is changing the face of clinical practice and medical education. Worldwide consensus based on expert opinion has advocated for POCUS teaching in undergraduate medical school curricula. Significant barriers, including lack of available instructors and limited resources, prevents medical learners from acquiring core competencies at most institutions. Here, we describe a peer-to-peer learning POCUS workshop and advocate for the use of this type of training to meet the demands of POCUS learning. Methods: A two-day POCUS workshop was held in Toronto, Ontario with twenty-six medical student participants. The workshop was structured according to a graduated model of POCUS skill development, beginning with didactic teaching, then progressing to hands-on peer-to-peer teaching, and finishing with competency evaluation by POCUS experts. Participants completed pre-and post-workshop surveys regarding prior POCUS teaching and exposure, self-reported skill development, and feedback on the workshop itself. Results: Of the 20 respondents to the questionnaire, 70% had prior POCUS exposure, with 85% of these individuals having less than 5 hours of prior POCUS education. Eighty-five percent of students reported that the organization of the course allowed them to participate fully, and 95% of participants indicated that peer-to-peer learning was effective. Conclusion: These findings suggest that peer-to-peer POCUS teaching is an effective learning method to acquire and consolidate well-established POCUS competencies. This initiative is scalable and could be applied to all learners in various disciplines. As such, we recommend medical schools consider integration of peer-to-peer POCUS teaching into longitudinal clerkship training programs, and transition-to-residency courses

Learning Through Serving: Learning Service-Learning Pedagogy to Enhance your Teaching

This workshop is geared toward faculty and staff at universities who would want to integrate service learning into their courses as well as community partners who would like to explore a service-learning opportunity with a campus partner. The definition of service learning and how it is different from other forms of experiential learning will be discussed. Concepts will be illustrated using a short video clip and other real life examples. The service learning criteria of Meaningful Service, Enhanced Academic Learning, and Purposeful Civic Learning will be identified. The application of these criteria will be illustrated through BGSU service-learning courses - the Listening Post and Small Group Communication are two courses that have integrated older adults into the curriculum. Specific examples and strategies will be described. The role and importance of continuous reflection will be described. Participants will receive handouts on the What, So What, Now What model and the DEAL Model of Critical Reflection. Emphasis on the mutual benefit for community partners will be shared along with best practices in Community Partnerships.Participants will have the opportunity to brainstorm potential courses and community partnerships for service-learning. Using an Action Plan handout, faculty and staff participants will identify new or existing courses at their institutions to apply service-learning pedagogy, identify one learning objective related to each criteria, list potential community partner to support learning objectives, and list potential challenges. Community partner participants and practitioners will have the opportunity to develop a partnership action plan. They will receive a similar Action Plan handout to brainstorm how their organization might be able to utilize a service-learning partnership; identifying potential projects, why they would fit as service-learning, and what action steps they could take to initiate a partnership with a local campus. Additional resources for service-learning will be identified including Ohio Campus Compact (funding, program models), Campus Compact syllabi database, and Offices of Service-Learning on various campuses

Uptake of hepatitis C specialist services and treatment following diagnosis by dried blood spot in Scotland

Background: Dried blood spot (DBS) testing for hepatitis C (HCV) was introduced to Scotland in 2009. This minimally invasive specimen provides an alternative to venipuncture and can overcome barriers to testing in people who inject drugs (PWID). Objectives: The objective of this study was to determine rates and predictors of: exposure to HCV, attendance at specialist clinics and anti-viral treatment initiation among the DBS tested population in Scotland. Study design: DBS testing records were deterministically linked to the Scottish HCV Clinical database prior to logistic regression analysis. Results: In the first two years of usage in Scotland, 1322 individuals were tested by DBS of which 476 were found to have an active HCV infection. Linkage analysis showed that 32% had attended a specialist clinic within 12 months of their specimen collection date and 18% had begun anti-viral therapy within 18 months of their specimen collection date. A significantly reduced likelihood of attendance at a specialist clinic was evident amongst younger individuals (<35 years), those of unknown ethnic origin and those not reporting injecting drug use as a risk factor. Conclusion: We conclude that DBS testing in non-clinical settings has the potential to increase diagnosis and, with sufficient support, treatment of HCV infection among PWID

Designing interactive newsprint

The possibility of linking paper to digital information is enhanced by recent developments in printed electronics. In this article we report the design and evaluation of a local newspaper augmented with capacitive touch regions and an embedded Bluetooth chip working with an adjunct device. These allowed the interactive playback of associated audio and the registration of manual voting actions on the web. Design conventions inherited from paper and the web were explored by showing four different versions of an interactive newspaper to 16 community residents. The diverse responses of residents are described, outlining the potential of the approach for local journalism and recommendations for the design of interactive newsprint

Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs

Background: Although people who inject drugs (PWID) are an important group to receive Hepatitis C Virus (HCV) antiviral therapy, initiation onto treatment remains low. Concerns over reinfection may make clinicians reluctant to treat this group. We examined the risk of HCV reinfection among a cohort of PWID (encompassing all those reporting a history of injecting drug use) from Scotland who achieved a sustained virological response (SVR). Methods: Clinical and laboratory data were used to monitor RNA testing among PWID who attained SVR following therapy between 2000 and 2009. Data were linked to morbidity and mortality records. Follow-up began one year after completion of therapy, ending on 31st December, 2012. Frequency of RNA testing during follow-up was calculated and the incidence of HCV reinfection estimated. Cox proportional hazards regression was used to examine factors associated with HCV reinfection. Results: Among 448 PWID with a SVR, 277 (61.8%) were tested during follow-up, median 4.5 years; 191 (69%) received one RNA test and 86 (31%) received at least two RNA tests. There were seven reinfections over 410 person years generating a reinfection rate of 1.7/100 py (95% CI 0.7–3.5). For PWID who have been hospitalised for an opiate or injection related cause post SVR (11%), the risk of HCV reinfection was greater [AHR = 12.9, 95% CI 2.2–76.0, p = 0.002] and the reinfection rate was 5.7/100 py (95% CI 1.8–13.3). Conclusion: PWID who have been tested, following SVR, for HCV in Scotland appear to be at a low risk of reinfection. Follow-up and monitoring of this population are warranted as treatment is offered more widely

Natural experiments for the evaluation of place-based public health interventions:a methodology scoping review

Place-based public health evaluations are increasingly making use of natural experiments. This scoping review aimed to provide an overview of the design and use of natural experiment evaluations (NEEs), and an assessment of the plausibility of the as-if randomisation assumption. A systematic search of three bibliographic databases (Pubmed, Web of Science and Ovid-Medline) was conducted in January 2020 to capture publications that reported a natural experiment of a place-based public health intervention or outcome. For each, study design elements were extracted. An additional evaluation of as-if randomisation was conducted by twelve 12 of this paper’s authors who evaluated the same set of 20 randomly selected studies and assessed ‘as-if’ randomisation for each. 366 NEE studies of place-based public health interventions were identified. The most commonly used NEE approach was a Difference-in-Differences study design (25%), followed by before-after comparisons studies (23%) and regression analysis studies. 42% of NEEs had likely or probably as-if randomisation of exposure (the intervention), while for 25% this was implausible. An inter-rater agreement exercise indicated poor reliability of as-if randomisation assignment. Only about half of NEEs reported some form of sensitivity or falsification analysis to support inferences. NEEs are conducted using many different designs and statistical methods and encompass various definitions of a natural experiment, while it is questionable whether all evaluations reported as natural experiments should be considered as such. The likelihood of as-if randomisation should be specifically reported, and primary analyses should be supported by sensitivity analyses and/or falsification tests. Transparent reporting of NEE designs and evaluation methods will contribute to the optimum use of place-based NEEs