Family-centered rounds and medical student performance on the NBME pediatrics subject (shelf) examination: a retrospective cohort study

Objective To determine the association between family-centered rounds (FCR) and medical student knowledge acquisition as assessed by the National Board of Medical Examiners (NBME) pediatric subject (shelf) exam. Methods A retrospective cohort study was conducted of third-year medical students who graduated from Virginia Commonwealth University School of Medicine between 2009 and 2014. This timeframe represented the transition from ‘traditional’ rounds to FCR on the pediatric inpatient unit. Data collected included demographics, United States Medical Licensing Examination (USMLE) Step 1 and 2 scores, and NBME subject examinations in pediatrics (PSE), medicine (MSE), and surgery (SSE). Results Eight hundred and sixteen participants were included in the analysis. Student performance on the PSE could not be statistically differentiated from performance on the MSE for any year except 2011 (z-score=−0.17, p=0.02). Average scores on PSE for years 2009, 2010, 2013, and 2014 were significantly higher than for SSE, but not significantly different for all other years. The PSE was highly correlated with USMLE Step 1 and Step 2 examinations (correlation range 0.56–0.77) for all years. Conclusions Our results showed no difference in PSE performance during a time in which our institution transitioned to FCR. These findings should be reassuring for students, attending physicians, and medical educators

Lipid-modulated assembly of magnetized iron-filled carbon nanotubes in millimeter-scale structures

Biomolecule-functionalized carbon nanotubes (CNTs) combine the molecular recognition properties of biomaterials with the electrical properties of nanoscale solid state transducers. Application of this hybrid material in bioelectronic devices requires the development of methods for the reproducible self-assembly of CNTs into higher-order structures in an aqueous environment. To this end, we have studied pattern formation of lipid-coated Fe-filled CNTs, with lengths in the 1–5 µm range, by controlled evaporation of aqueous CNT-lipid suspensions. Novel diffusion limited aggregation structures composed of end-to-end oriented nanotubes were observed by optical and atomic force microscopy. Significantly, the lateral dimension of assemblies of magnetized Fe-filled CNTs was in the millimeter range. Control experiments in the absence of lipids and without magnetization indicated that the formation of these long linear nanotube patterns is driven by a subtle interplay between radial flow forces in the evaporating droplet, lipid-modulated van der Waals forces, and magnetic dipole–dipole interactions. Keywords

Molecular Gas Content of HI Monsters and Implications to Cold Gas Content Evolution in Galaxies

We present 12CO (J=1-0) observations of a sample of local galaxies (0.04<z<0.08) with a large neutral hydrogen reservoir, or "HI monsters". The data were obtained using the Redshift Search Receiver on the FCRAO 14 m telescope. The sample consists of 20 HI-massive galaxies with M(HI)>3e10Msun from the ALFALFA survey and 8 LSBs with a comparable M(HI) (>1.5e10Msun). Our sample selection is purely based on the amount of neutral hydrogen, thereby providing a chance to study how atomic and molecular gas relate to each other in these HI-massive systems. We have detected CO in 15 out of 20 ALFALFA selected galaxies and 4 out of 8 LSBs with molecular gas mass M(H2) of (1-11)e9Msun. Their total cold gas masses of (2-7e10Msun make them some of the most gas-massive galaxies identified to date in the Local Universe. Observed trends associated with HI, H2, and stellar properties of the HI massive galaxies and the field comparison sample are analyzed in the context of theoretical models of galaxy cold gas content and evolution, and the importance of total gas content and improved recipes for handling spatially differentiated behaviors of disk and halo gas are identified as potential areas of improvement for the modeling.Comment: 18 pages, 11 figures, 2 tables; Accepted for publication in MNRA

How Massless Neutrinos Affect the Cosmic Microwave Background Damping Tail

We explore the physical origin and robustness of constraints on the energy density in relativistic species prior to and during recombination, often expressed as constraints on an effective number of neutrino species, Neff. Constraints from current data combination of Wilkinson Microwave Anisotropy Probe (WMAP) and South Pole Telescope (SPT) are almost entirely due to the impact of the neutrinos on the expansion rate, and how those changes to the expansion rate alter the ratio of the photon diffusion scale to the sound horizon scale at recombination. We demonstrate that very little of the constraining power comes from the early Integrated Sachs-Wolfe (ISW) effect, and also provide a first determination of the amplitude of the early ISW effect. Varying the fraction of baryonic mass in Helium, Yp, also changes the ratio of damping to sound-horizon scales. We discuss the physical effects that prevent the resulting near-degeneracy between Neff and Yp from being a complete one. Examining light element abundance measurements, we see no significant evidence for evolution of Neff and the baryon-to-photon ratio from the epoch of big bang nucleosynthesis to decoupling. Finally, we consider measurements of the distance-redshift relation at low to intermediate redshifts and their implications for the value of Neff.Comment: 11 pages. Replaced version extends our discussion of origin of constraints and updates for current data, submitted to PR

A Catalog of MIPSGAL Disk and Ring Sources

We present a catalog of 416 extended, resolved, disk- and ring-like objects as detected in the MIPSGAL 24 micron survey of the Galactic plane. This catalog is the result of a search in the MIPSGAL image data for generally circularly symmetric, extended "bubbles" without prior knowledge or expectation of their physical nature. Most of the objects have no extended counterpart at 8 or 70 micron, with less than 20% detections at each wavelength. For the 54 objects with central point sources, the sources are nearly always seen in all IRAC bands. About 70 objects (16%) have been previously identified, with another 35 listed as IRAS sources. Among the identified objects, those with central sources are mostly listed as emission-line stars, but with other source types including supernova remnants, luminous blue variables, and planetary nebulae. The 57 identified objects (of 362) without central sources are nearly all PNe (~90%).which suggests that a large fraction of the 300+ unidentified objects in this category are also PNe. These identifications suggest that this is primarily a catalog of evolved stars. Also included in the catalog are two filamentary objects that are almost certainly SNRs, and ten unusual compact extended objects discovered in the search. Two of these show remarkable spiral structure at both 8 and 24 micron. These are likely background galaxies previously hidden by the intervening Galactic plane

Tracing Galaxy Assembly: Tadpole Galaxies in the Hubble Ultra Deep Field

In the Hubble Ultra Deep Field (HUDF) an abundance of galaxies is seen with a knot at one end plus an extended tail, resembling a tadpole. These "tadpole galaxies" appear dynamically unrelaxed--presumably in an early merging state--where tidal interactions likely created the distorted knot-plus-tail morphology. Here we systematically select tadpole galaxies from the HUDF and study their properties as a function of their photometric redshifts. In a companion HUDF variability study, Cohen et al. (2005) revealed a total of 45 variable objects believed to be Active Galactic Nuclei (AGN). Here we show that this faint AGN sample has no overlap with the tadpole galaxy sample, as predicted by theoretical work. The tadpole morphology--combined with the lack of overlap with the variable objects--supports the idea that these galaxies are in the process of an early-stage merger event, i.e., at a stage that likely precedes the "turn-on" of any AGN component and the onset of any point-source variability.Comment: 7 pages, 4 figures. Accepted for publication by Astrophysical Journa

Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention

Background: Access and equity in children’s therapy services may be improved by directing clinicians’ use of resources toward specific goals that are important to patients. A practice-change intervention (titled ‘Good Goals’) was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children’s occupational therapy services. Methods: Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and ‘tools for change’. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers’ observations. Results: Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists’ time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists’ behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children’s LoT decreased by two months [95% CI −8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists’ salary bands. Conclusions: Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts