A Prospective Evaluation of Point of Care Ultrasound Teaching in Switzerland.

ContextAs the utility of point-of-care ultrasound (POCUS) continues to expand in the medical field, there is a need for effective educational methods. In Switzerland, medical education follows the European model and lasts 6 years, focusing on preclinical training during the first 2 years. No previous studies have evaluated the optimal time for teaching ultrasound in European medical education.AimsThe aim of this study is to provide ultrasound training to medical students in Switzerland at varying times during their clinical training to determine if the level of training plays a role in their ability to comprehend and to apply basic POCUS skills.MethodsWe performed an observational study utilizing a convenience sample of Swiss medical students between July 11, 2016 and August 6, 2016. They were taught a 2-day POCUS course by five American-trained 1st-year medical students. Following this course, students were evaluated with written and clinical examination.Results100 Swiss medical students were enrolled in the study. A total of 59 of these students were early clinical students, and 41 students were late clinical students. A two-tailed t-test was performed and demonstrated that the late clinical students performed better than the early clinical students on the written assessment; however, no difference was found in clinical skill.ConclusionOur data suggest that Swiss medical students can learn and perform POCUS after a 2-day instructional taught by trained 1st-year American medical students. No difference was found between students in early clinical training and late clinical training for the ability to perform POCUS

Termite sensitivity to temperature affects global wood decay rates.

Deadwood is a large global carbon store with its store size partially determined by biotic decay. Microbial wood decay rates are known to respond to changing temperature and precipitation. Termites are also important decomposers in the tropics but are less well studied. An understanding of their climate sensitivities is needed to estimate climate change effects on wood carbon pools. Using data from 133 sites spanning six continents, we found that termite wood discovery and consumption were highly sensitive to temperature (with decay increasing >6.8 times per 10°C increase in temperature)-even more so than microbes. Termite decay effects were greatest in tropical seasonal forests, tropical savannas, and subtropical deserts. With tropicalization (i.e., warming shifts to tropical climates), termite wood decay will likely increase as termites access more of Earth's surface

Establishing Interest in the Development of a Novel Telehealth Curriculum for Emergency Medicine Resident Physicians

Learning Objectives: To assess EM resident enthusiasm for a telehealth curriculum and to develop a series of telehealth training modules for EM resident physicians.Introduction/Background: According to the American College of Emergency Physicians (ACEP), emergency telehealth is a core domain of emergency medicine (EM) and is inclusive of remotely providing acute medical care. In 2016, the American Medical Association Council on Medical Education released a report advocating for the implementation of formalized telehealth training into graduate medical education accreditation requirements. There was rapid growth in telehealth during the COVID-19 pandemic: An industry analysis showed overall telehealth utilization grew 38 times from February 2020 to February 2021. Despite this, training in telehealth for residents remains substandard, with experts calling for formal curricula. To our knowledge there is no standardized graduate medical education curriculum for telehealth.Objective: To assess EM resident enthusiasm for a telehealth curriculum and to develop a series of telehealth training modules for EM resident physicians.Curricular Design: We distributed a ten question survey to 44 EM residents to gauge their interest in pursuing telehealth education. We developed a series of 30 minute modules focused on different aspects of telehealth delivery targeted to an audience of EM residents. We created four key telehealth learning modules to train EM residents: Historical Socioeconomic Relevance, The Virtual Patient Encounter, The Telehealth Physical Exam, and Documentation Medicolegal Implications.Impact/Effectiveness: The vast majority of survey respondents feel that telehealth education is probably or definitely important, and would pursue education in telehealth. Future directions include soliciting feedback from residents who complete the curriculum and learning assessment. As telehealth continues its rapid growth beyond a protracted pandemic it is critical that we educate and equip the next generation of emergency physicians to harness the skills to provide emergency telehealth services to their patients

Drivers of deadwood decay of 13 temperate tree species are similar between forest and grassland habitats

Deadwood provides an important carbon source in forests and wooded ecosystems and, accordingly, forest management strategies discuss the enrichment of deadwood amount and diversity by different tree species. To investigate the decomposition processes of enriched deadwood, we simultaneously placed 3,669 size-standardized and gamma sterilized wood specimens of 13 tree species (Populus tremula, Tilia cordata, Prunus avium, Betula pendula, Carpinus betulus, Fraxinus excelsior, Quercus robur, Fagus sylvatica, Acer platanoides, Larix decidua, Pinus sylvestris, Picea abies, and Pseudotsuga menziesii) at a total of 300 forest and grassland plots in three regions in Germany covering large gradients of management intensity and environmental conditions. After 1 year, mass loss was calculated and its relationship with wood traits and environmental conditions was assessed to determine the most important factors. Mass loss was overall higher in forest compared to grassland habitats, with wood traits as the most important driver, followed by region and environmental factors related to microclimate. However, management intensity was less relevant to explain the mass loss in both habitats. Our results suggest that decomposition of enriched deadwood, even after removal of endophytes, is influenced by the same drivers (positively by moisture and abundance of macronutrients, negatively by lignin and phenol concentration) as naturally occurring wood. Furthermore, due to the immense and standardized experimental setting, our study contributes to a better understanding of the important drivers of mass loss in different tree species and thus provides the basis for predictions of the carbon cycle in a changing world.ISSN:2624-893

A Prospective Evaluation of Point of Care Ultrasound Teaching in Switzerland.

ContextAs the utility of point-of-care ultrasound (POCUS) continues to expand in the medical field, there is a need for effective educational methods. In Switzerland, medical education follows the European model and lasts 6 years, focusing on preclinical training during the first 2 years. No previous studies have evaluated the optimal time for teaching ultrasound in European medical education.AimsThe aim of this study is to provide ultrasound training to medical students in Switzerland at varying times during their clinical training to determine if the level of training plays a role in their ability to comprehend and to apply basic POCUS skills.MethodsWe performed an observational study utilizing a convenience sample of Swiss medical students between July 11, 2016 and August 6, 2016. They were taught a 2-day POCUS course by five American-trained 1st-year medical students. Following this course, students were evaluated with written and clinical examination.Results100 Swiss medical students were enrolled in the study. A total of 59 of these students were early clinical students, and 41 students were late clinical students. A two-tailed t-test was performed and demonstrated that the late clinical students performed better than the early clinical students on the written assessment; however, no difference was found in clinical skill.ConclusionOur data suggest that Swiss medical students can learn and perform POCUS after a 2-day instructional taught by trained 1st-year American medical students. No difference was found between students in early clinical training and late clinical training for the ability to perform POCUS

Eradication of chronic HCV infection: improvement of dysbiosis only in patients without liver cirrhosis.

It is well accepted that liver diseases and their outcomes are associated with intestinal microbiota but causality is difficult to establish. The intestinal microbiota is altered in patients with hepatitis C. As chronic HCV infection can now be cured in almost all patients, it is an ideal model to study the influence of liver disease on the microbiota. We aimed to analyze prospectively the changes in the gut microbiome in patients who received direct acting antivirals (DAA) and achieved sustained virological response (SVR). Amplicon sequencing of the V1-V2 region in the 16S rRNA gene was performed in stool samples of patients with chronic hepatitis C. Patients in the treatment group received direct acting antivirals (n=65) whereas in the control group no DAA were given (n=33). Only patients achieving SVR were included. The alpha diversity increased numerical but not significantly from baseline to SVR24/48 (2.784±0.248 vs. 2.846±0.224; p= 0.057). When stratifying for the presence of liver cirrhosis, a significant increase in diversity was only seen in patients without cirrhosis. Differences in the microbial community structure induced by the achievement of SVR were only observed in patients without liver cirrhosis. In patients with liver cirrhosis and in the control group, no significant differences were observed. In conclusion, the achievement of SVR24/48 in patients with chronic HCV was associated with changes in the intestinal microbiota. However, these changes were only seen in patients without liver cirrhosis. A major role of liver remodeling on the intestinal microbiota is indicated by the dynamics of the intestinal microbial community structure depending on the stage of fibrosis in patients resolving chronic hepatitis C