COMPARING THE RATE OF PARASITIC INFECTION AMONG PEOPLE OF RIGORES, HONDURAS TO GUATEMALA

poster abstractHonduras is the second poorest country in Central America, and thousands of its residents are living without access to medical care. Parasites are an everyday reality there, and rates are more than double that of Guatemala. The Honduras ENLACE Project at Indiana University School of Medicine De-partment of Family Medicine sends medical brigades to Rigores, Honduras to help combat this. The Department of Family Medicine wants to know why Honduras has such high rates of parasites compared to its neighbor of Gua-temala. This research analyzes the data from the March 2011 brigade and compares it to national health data from Guatemala. Problems common to Honduras were reflected in the data and were not surprising. These included diabetes, hypertension, malnutrition, and parasitic infections. Comparisons showed people living in Guatemala have lower rates of parasites, hyperten-sion, diabetes, and are better nourished. There could be many factors affect-ing the disparity in health between Guatemala and Honduras. The data col-lected and analyzed from Rigores compared to that of Guatemala may help future brigade teams help decrease the parasitic infection rate. Many thanks go to the Life Health Sciences Internship Program for funding and making this possible

Developing a Just-in-Time Adaptive Mobile Platform for Family Medicine Education: Experiential Lessons Learned

EASEL is a platform designed to provide just-in-time adaptive support to students during experiential learning interviews conducted as part of required work in an online course in a family medicine education program in a Midwestern urban university setting EASEL considers the time and location of the student and provides questions and content before, during, and after the interviews take place EASEL will provide a new way to facilitate and support online family medicine students as they meet with patients and healthcare professionals This paper presents a look at the considerations, issues, and lessons learned during the development process of this interdisciplinary collaborative effort between the platform designers and family medicine faculty while working toward completion of the stud

How interacting constraints shape emergent decision-making of national level football referees

Here we sought to add to understanding of how and why football referees make decisions. A grounded theory methodology was undertaken to tap into the experiential knowledge of 9 national level referees (aged 23 to 35 yrs). Results indicated that referee decision-making actions were not predominantly aimed at traditional notions of decision-making accuracy (e.g., correctly identifying rule transgressions), but were instead focussed on meeting two overarching task goals: maintaining control and preserving the integrity of the competitive game. These objectives were, in part, informed by co-invested task outcomes which referees perceived that players, spectators, coaches and fellow referees had about 'how the game should be played'. Analysis revealed ‘four pillars’ used to meet these expectations, which were conceptual notions of: safety, fairness, accuracy and entertainment. These findings showed that: (i) referees co-construct the game with players, and that (ii), referee decision-making is an emergent process of the performer-environment relationship nested within task goals. It was concluded that: (i) decision-making accuracy should be viewed very much within the context of a competitive match, and (ii), distinctions should be made between types of bias and the complex strategies that referees use to manage the game

Effects of prestrain on the ductile-to-brittle transition of ice

AbstractThe ductile-to-brittle transition was investigated in prestrained columnar ice at −10 °C. Laboratory-grown specimens of freshwater and saline ice were prestrained under uniaxial across-column compression (to levels from εp = 0.003 to εp = 0.20, at constant strain rates in the ductile regime) and likewise reloaded (at rates from 1 × 10−6s−1 to 3 × 10−2s−1). Prestrain caused solid-state recrystallization as well as damage in the form of non-propagating microcracks. The ductile-to-brittle transition strain rate ε˙D/B increased by a factor of 3–10 after prestrain of εp = 0.035 in both freshwater and saline ice, compared to that of initially undamaged ice of the same type. Additional prestrain had little further effect on ε˙D/B. The results are interpreted within the framework of a model (proposed by Schulson, 1990, and Renshaw and Schulson, 2001) that predicts the transition strain rate based on the micromechanical boundary between creep and fracture processes. Model parameters primarily affected by prestrain were the power-law creep coefficient B (more so than the creep exponent n), Young's modulus E and, by extension, the fracture toughness KIc

The Role of Damage and Recrystallization in the Elastic Properties of Columnar Ice

Effects of damage on elastic properties were studied in columnar-grained specimens of freshwater and saline ice, subjected, at −10°C, to varying levels of inelastic strain. The ice was compressed uniaxially at constant strain rates up to 0.20 strain, which caused localized recrystallization and imparted damage in the form of non-propagating cracks. Damage was quantified in terms of dimensionless crack density, which, along with recrystallized area fraction, was determined from thin sections. The change in porosity due to stress-induced cracks served as another indicator of damage. Elastic properties were derived using P-wave and S-wave ultrasonic transmission velocities measured in across-column directions through the damaged ice, either parallel (x 1) or perpendicular (x 2) to the initial loading direction. In general, as damage increased with greater strain, the ice became more compliant and (particularly freshwater ice) more anisotropic. Furthermore, with increasing strain rate, the magnitude of these effects and crack density tended to increase, in contrast to the recrystallized area fraction, which tended to decrease. We observed compliance to correspond closely with porosity and with dimensionless crack density, for strains up to 0.10. At greater levels of strain these correspondences became less clear due, in part, to the different character of the damage

Calling The Dead: Resilience In The WTC Communication Networks

Organizations in emergency settings must cope with various sources of disruption, most notably personnel loss. Death, incapacitation, or isolation of individuals within an organizational communication network can impair information passing, coordination, and connectivity, and may drive maladaptive responses such as repeated attempts to contact lost personnel (``calling the dead'') that themselves consume scarce resources. At the same time, organizations may respond to such disruption by reorganizing to restore function, a behavior that is fundamental to organizational resilience. Here, we use empirically calibrated models of communication for 17 groups of responders to the World Trade Center Disaster to examine the impact of exogenous removal of personnel on communication activity and network resilience. We find that removal of high-degree personnel and those in institutionally coordinative roles is particularly damaging to these organizations, with specialist responders being slower to adapt to losses. However, all organizations show adaptations to disruption, in some cases becoming better connected and making more complete use of personnel relative to control after experiencing losses

Understanding Traumatic Brain Injury in the Primary Care Setting

poster abstractBackground: TBI is being re-conceptualized as a chronic disease causative agent rather than as a single, acute event. This study examined how familiar family medicine physicians (PCPs) are with TBI and their level of confidence in treating TBI sequelae likely to be seen in primary care. We also examined PCP attitudes regarding care for post-acute mild TBI and moderate/severe TBI in primary care and how recently the respondent had cared for a mild TBI and/or moderate/severe TBI patient. Methods: The study featured a mixed methods study design. A survey was administered on paper and electronically. A semi-structured qualitative interview guide was developed based upon survey responses. Descriptive statistics were calculated. Results: Most respondents associated neurological symptoms/conditions as TBI sequelae: irritability, 100.0%, fatigue, 98.0%; insomnia, 88.2%, depression, 98.0%, headaches, 98.0%, anxiety, 80.4%. Two-thirds (66.7%) identified epilepsy as a condition associated with TBI. Just over one-half associated tinnitus (51.0%) or loss of libido (52.9%) with TBI while only one-third (33.3%) associated incontinence with TBI. Most physicians felt confident treating depression (84.0%), anxiety (82.4%), headache (80.4%) and insomnia (76.0%). Physicians felt less confident in treating fatigue (68.0%), irritability (68.0%), incontinence (51.2%) and loss of libido (50.0%). The least amount of confidence was claimed in treating epilepsy (37.5%) and tinnitus (36.4%). All respondents (100.0%) believed that a PCP can manage post-acute mild TBI (concussion) care while 52.0% agreed that a PCP can manage post-acute care for moderate/severe TBI. Only one respondent (2.0%) had never cared for a mild TBI patient. Most (70.6%) had cared for a moderate/severe TBI patient within the past two years while 5.9% had cared for one of these patients more than a year ago. Nearly twenty percent (19.7%) had never cared for a moderate/severe TBI patient and 3.9% were unsure if they had

Plastic Faulting in Saltwater Ice

Compression experiments on laboratory-grown columnar S2 saltwater ice loaded triaxially through proportional loading at T = –20°C at applied strain rates of ε = 10–5–10–1 s–1 demonstrate that plastic (P) faulting is a mode of failure in saltwater ice when rapidly loaded under a high degree of confinement. In terms of microstructure, mechanical behavior and strength, saltwater ice that fails via P-faulting is almost indistinguishable from columnar S2 freshwater ice that fails via P-faulting loaded under the same conditions. The results also demonstrate that saltwater ice loaded rapidly may exhibit yet another mode of failure, in addition to P-faulting, through what appears to be a mechanism of pore collapse

Opioid Overdose Prevention in Family Medicine Clerkships: A CERA Study

BACKGROUND AND OBJECTIVES: The national opioid crisis requires medical education to develop a proactive response centering on prevention and treatment. Primary care providers (PCPs)—many of whom are family medicine physicians—commonly treat patients on opiates, and write nearly 50% of opioid prescriptions. Despite linkages between PCP opioid prescribing patterns and the associated potential for overdose, little is known about how family medicine clerkship students are trained to prevent opioid overdose, including training on the use of naloxone. This study describes the presence of opioid overdose education at the national level and barriers to inclusion. It also discusses implementation strategies along with instructional methodology and learner evaluation. METHODS: Data were collected as part of a cross-sectional survey administered electronically by the Council of Academic Family Medicine Educational Research Alliance to 139 family medicine clerkship directors. RESULTS: A total of 99 clerkship directors (71.2% response rate) responded to the survey. A large majority (86.4%) agreed that it is important to offer opioid overdose prevention education in the clerkship, yet only 25.8% include this topic. Of these, only 50.0% address naloxone use. The most common barriers to including opioid overdose prevention education were prioritization of educational topics (82.1%) followed by lack of available faculty with sufficient experience/expertise (67.7%). CONCLUSIONS: Findings point to a disparity between perceived importance of opioid overdose prevention education and inclusion of this topic in family medicine clerkship-level medical education. Innovative use of online education and partnering with community resources may address barriers related to curricular prioritization while supporting interprofessional education principles

Brain Phosphorus Magnetic Resonance Spectroscopy Imaging of Sleep Homeostasis and Restoration in Drug Dependence

Numerous reports have documented a high occurrence of sleep difficulties in drug-dependent populations, prompting researchers to characterize sleep profiles and physiology in drug abusing populations. This mini-review examines studies indicating that drug-dependent populations exhibit alterations in sleep homeostatic and restoration processes in response to sleep deprivation. Sleep deprivation is a principal sleep research tool that results in marked physiological challenge, which provides a means to examine sleep homeostatic processes in response to extended wakefulness. A report from our laboratory demonstrated that following recovery sleep from sleep deprivation, brain high-energy phosphates particularly beta–nucleoside triphosphate (beta-NTP) are markedly increased as measured with phosphorus magnetic resonance spectroscopy (MRS). A more recent study examined the effects of sleep deprivation in opiate-dependent methadone-maintained (MM) subjects. The study demonstrated increases in brain beta-NTP following recovery sleep. Interestingly, these increases were of a markedly greater magnitude in MM subjects compared to control subjects. A similar study examined sleep deprivation in cocaine-dependent subjects demonstrating that cocaine-dependent subjects exhibit greater increases in brain beta-NTP following recovery sleep when compared to control subjects. The studies suggest that sleep deprivation in both MM subjects and cocaine-dependent subjects is characterized by greater changes in brain ATP levels than control subjects. Greater enhancements in brain ATP following recovery sleep may reflect a greater disruption to or impact of sleep deprivation in drug dependent subjects, whereby sleep restoration processes may be unable to properly regulate brain ATP and maintain brain high-energy equilibrium. These studies support the notion of a greater susceptibility to sleep loss in drug dependent populations. Additional sleep studies in drug abusing populations are needed, particularly those that examine potential differential effects of sleep deprivation