International clinical rotations during U.S. residency training: Creating an accreditation council for graduate medical education-approved rotation

Healthcare professionals increasingly report interest in global health and participation in international healthcare delivery. Growth opportunities exist for trainees to improve knowledge, skills and attitudes through international experiences. Professional development via international medicine may have lasting effects on patient care and practice patterns following training. In 2010, the first resident took part in an international, exchange elective between The George Washington University’s Department of Anesthesiology in Washington, DC and La Universidad de San Francisco’s Department of Anesthesiology in Quito, Ecuador. This resident elective rotation resulted from a strategic partnership, initiated in 2008, between two training institutions with an established track record of medical student educational exchange programs. The goal of any resident elective rotation should be to enhance an educational experience, to improve upon a perceived training deficiency, or to create a unique offering that takes advantage of local assets and connections. International electives, if properly conceived, can accomplish all three goals. This guide for program leadership addresses the rationale and challenges, from concept to Accreditation Council for Graduate Medical Education approval, of creating an international clinical rotation for residents

A Laboratory Investigation of Supersonic Clumpy Flows: Experimental Design and Theoretical Analysis

We present a design for high energy density laboratory experiments studying the interaction of hypersonic shocks with a large number of inhomogeneities. These ``clumpy'' flows are relevant to a wide variety of astrophysical environments including the evolution of molecular clouds, outflows from young stars, Planetary Nebulae and Active Galactic Nuclei. The experiment consists of a strong shock (driven by a pulsed power machine or a high intensity laser) impinging on a region of randomly placed plastic rods. We discuss the goals of the specific design and how they are met by specific choices of target components. An adaptive mesh refinement hydrodynamic code is used to analyze the design and establish a predictive baseline for the experiments. The simulations confirm the effectiveness of the design in terms of articulating the differences between shocks propagating through smooth and clumpy environments. In particular, we find significant differences between the shock propagation speeds in a clumpy medium compared to a smooth one with the same average density. The simulation results are of general interest for foams in both inertial confinement fusion and laboratory astrophysics studies. Our results highlight the danger of using average properties of inhomogeneous astrophysical environments when comparing timescales for critical processes such as shock crossing and gravitational collapse times.Comment: 7 pages, 6 figures. Submitted to the Astrophysical Journal. For additional information, including simulation animations and the pdf and ps files of the paper with embedded high-quality images, see http://pas.rochester.edu/~wm

Motivation as a predictor of outcomes in school-based humanistic counselling

Recent years have seen a growth in the provision of counselling within UK secondary schools, and research indicates that it is associated with significant reductions in psychological distress. However, little is known about the moderators and mediators of positive therapeutic benefit. In the field of adult mental health, motivation has been found to be one of the strongest predictors of therapeutic outcomes, and it was hypothesised that this may also be a predictor of outcomes for young people in school-based counselling services. To assess the relationship between young people’s motivation for counselling and its effectiveness within a secondary school setting. Eighty-one young people (12 - 17 years old) who attended school-based humanistic counselling services in Scotland. Clients completed a measure of motivation for counselling at the commencement of their therapeutic work and a measure of psychological wellbeing at the commencement and termination of counselling. Motivation for counselling was not found to be significantly related to outcomes. The results indicate that the association between motivation and outcomes may be weaker in young people as compared with adults. However, a number of design factors may also account for the non-significant findings: insufficient participants, marginal reliability of the motivation measure and social desirability effects

Generalized Farey trees, transfer Operators and phase transitions

We consider a family of Markov maps on the unit interval, interpolating between the tent map and the Farey map. The latter map is not uniformly expanding. Each map being composed of two fractional linear transformations, the family generalizes many particular properties which for the case of the Farey map have been successfully exploited in number theory. We analyze the dynamics through the spectral analysis of generalized transfer operators. Application of the thermodynamic formalism to the family reveals first and second order phase transitions and unusual properties like positivity of the interaction function.Comment: 39 pages, 10 figure

Logic and/of Truthmaking

The purpose of this paper is to explore the question of how truthmaker theorists ought to think about their subject in relation to logic. Regarding logic and truthmaking, I defend the view that considerations drawn from advances in modal logic have little bearing on the legitimacy of truthmaker theory. To do so, I respond to objections Timothy Williamson has lodged against truthmaker theory. As for the logic of truthmaking, I show how the project of understanding the logical features of the truthmaking relation has led to an apparent impasse. I offer a new perspective on the logic of truthmaking that both explains the problem and offers a way out

Diverse parameters of ambulatory knee moments differ with medial knee osteoarthritis severity and are combinable into a severity index

Objective: To characterize ambulatory knee moments with respect to medial knee osteoarthritis (OA) severity comprehensively and to assess the possibility of developing a severity index combining knee moment parameters.Methods: Nine parameters (peak amplitudes) commonly used to quantify three-dimensional knee moments during walking were analyzed for 98 individuals (58.7 ± 9.2 years old, 1.69 ± 0.09 m, 76.9 ± 14.5 kg, 56% female), corresponding to three medial knee osteoarthritis severity groups: non-osteoarthritis (n = 22), mild osteoarthritis (n = 38) and severe osteoarthritis (n = 38). Multinomial logistic regression was used to create a severity index. Comparison and regression analyses were performed with respect to disease severity.Results: Six of the nine moment parameters differed statistically significantly among severity groups (p ≤ 0.039) and five reported statistically significant correlation with disease severity (0.23 ≤ |r| ≤ 0.59). The proposed severity index was highly reliable (ICC = 0.96) and statistically significantly different between the three groups (p < 0.001) as well as correlated with disease severity (r = 0.70).Conclusion: While medial knee osteoarthritis research has mostly focused on a few knee moment parameters, this study showed that other parameters differ with disease severity. In particular, it shed light on three parameters frequently disregarded in prior works. Another important finding is the possibility of combining the parameters into a severity index, which opens promising perspectives based on a single figure assessing the knee moments in their entirety. Although the proposed index was shown to be reliable and associated with disease severity, further research will be necessary particularly to assess its validity

Experimental design for three interrelated marine ice sheet and ocean model intercomparison projects: MISMIP v. 3 (MISMIP +), ISOMIP v. 2 (ISOMIP +) and MISOMIP v. 1 (MISOMIP1)

Coupled ice sheet–ocean models capable of simulating moving grounding lines are just becoming available. Such models have a broad range of potential applications in studying the dynamics of marine ice sheets and tidewater glaciers, from process studies to future projections of ice mass loss and sea level rise. The Marine Ice Sheet–Ocean Model Intercomparison Project (MISOMIP) is a community effort aimed at designing and coordinating a series of model intercomparison projects (MIPs) for model evaluation in idealized setups, model verification based on observations, and future projections for key regions of the West Antarctic Ice Sheet (WAIS). Here we describe computational experiments constituting three interrelated MIPs for marine ice sheet models and regional ocean circulation models incorporating ice shelf cavities. These consist of ice sheet experiments under the Marine Ice Sheet MIP third phase (MISMIP+), ocean experiments under the Ice Shelf-Ocean MIP second phase (ISOMIP+) and coupled ice sheet–ocean experiments under the MISOMIP first phase (MISOMIP1). All three MIPs use a shared domain with idealized bedrock topography and forcing, allowing the coupled simulations (MISOMIP1) to be compared directly to the individual component simulations (MISMIP+ and ISOMIP+). The experiments, which have qualitative similarities to Pine Island Glacier Ice Shelf and the adjacent region of the Amundsen Sea, are designed to explore the effects of changes in ocean conditions, specifically the temperature at depth, on basal melting and ice dynamics. In future work, differences between model results will form the basis for the evaluation of the participating models