Athletic Training Student Core Competency Implementation During Patient Encounters

Context: Health care research evidence suggests that early patient encounters (PEs), as well as the purposeful implementation of professional core competencies (CCs), for athletic training students (ATSs) may be beneficial to their ability to provide care. However, no investigators have related facets of the clinical education experience with CC implementation as a form of summative assessment of the clinical experience. Objective: To determine the relationship between the frequency and length of PEs, as well as the student\u27s role and clinical site during PEs, and the students\u27 perceived CC implementation during these encounters. Design: Cross-sectional study. Setting: Professional athletic training program, National Collegiate Athletic Association Division I institution. Patients or Other Participants: We purposefully recruited 1 athletic training program that used E*Value software; 40 participants (31 females, 9 males) enrolled in the professional phase (12 first year, 14 second year, 14 third year) participated. Intervention(s): Participants viewed a 20-minute recorded CC educational module followed by educational handouts, which were also posted online for reference throughout the semester. The E*Value software was used to track PEs, including the type of encounter (ie, actual patient, practice encounter, didactic practice scenario), the type of site where the encounter occurred (university, high school), and the participant\u27s role (observed, assisted, performed), as well as responses to an added block of questions indicating which, if any, of the CCs were implemented during the PE. Main Outcome Measure(s): Variables per patient were PE length (minutes), participant role, site at which the encounter occurred, and whether any of the 6 CCs were implemented (yes/no). Variables per participant were average encounter length (minutes), encounter frequency, modal role, clinical site assignment, and the number of times each CC was implemented. Separate 1-way analyses of variance were used to examine the relationships between role or clinical site and implementation of total number of CCs. Multiple linear regressions were used to determine how the average length and frequency of PEs were related to the average and total number of implemented CCs. Binary logistic regression models indicated how the length of each encounter, role of the participant, and type of clinical site related to the implementation of each CC. Results:  The roles of participants during PEs were related to their ability to implement the total number of CCs (F = 103.48, P \u3c .001). Those who observed were likely to implement fewer total CCs than those who assisted (M diff = −0.29, P \u3c .001); those who assisted were likely to implement more total CCs than those who performed (M diff = 0.32, P \u3c .001). Frequency of encounters was the only significant variable in the model examining all independent variables with CC implementation (b4,32= 3.34, t = 9.46, P \u3c .001). Conclusions:  The role of the student, namely assisting during PEs, and the volume of PEs should be considered priorities for students to promote greater CC implementation

Classical blood biomarkers identify patients with higher risk for relapse 6 months after alcohol withdrawal treatment

This naturalistic study among patients with alcohol dependence examined whether routine blood biomarkers could help to identify patients with high risk for relapse after withdrawal treatment. In a longitudinal study with 6-month follow-up among 133 patients with alcohol dependence who received inpatient alcohol withdrawal treatment, we investigated the usefulness of routine blood biomarkers and clinical and sociodemographic factors for potential outcome prediction and risk stratification. Baseline routine blood biomarkers (gamma-glutamyl transferase GGT, alanine aminotransferase ALT/GPT, aspartate aminotransferase AST/GOT, mean cell volume of erythrocytes MCV), and clinical and sociodemographic characteristics were recorded at admission. Standardized 6~months' follow-up assessed outcome variables continuous abstinence, days of continuous abstinence, daily alcohol consumption and current abstinence. The combined threshold criterion of an AST:ALT ratio > 1.00 and MCV > 90.0 fl helped to identify high-risk patients. They had lower abstinence rates (P = 0.001), higher rates of daily alcohol consumption (P < 0.001) and shorter periods of continuous abstinence (P = 0.027) compared with low-risk patients who did not meet the threshold criterion. Regression analysis confirmed our hypothesis that the combination criterion is an individual baseline variable that significantly predicted parts of the respective outcome variances. Routinely assessed indirect alcohol biomarkers help to identify patients with high risk for relapse after alcohol withdrawal treatment. Clinical decision algorithms to identify patients with high risk for relapse after alcohol withdrawal treatment could include classical blood biomarkers in addition to clinical and sociodemographic items

AVPR1a and SLC6A4 Gene Polymorphisms Are Associated with Creative Dance Performance

Dancing, which is integrally related to music, likely has its origins close to the birth of Homo sapiens, and throughout our history, dancing has been universally practiced in all societies. We hypothesized that there are differences among individuals in aptitude, propensity, and need for dancing that may partially be based on differences in common genetic polymorphisms. Identifying such differences may lead to an understanding of the neurobiological basis of one of mankind's most universal and appealing behavioral traits—dancing. In the current study, 85 current performing dancers and their parents were genotyped for the serotonin transporter (SLC6A4: promoter region HTTLPR and intron 2 VNTR) and the arginine vasopressin receptor 1a (AVPR1a: promoter microsatellites RS1 and RS3). We also genotyped 91 competitive athletes and a group of nondancers/nonathletes (n = 872 subjects from 414 families). Dancers scored higher on the Tellegen Absorption Scale, a questionnaire that correlates positively with spirituality and altered states of consciousness, as well as the Reward Dependence factor in Cloninger's Tridimensional Personality Questionnaire, a measure of need for social contact and openness to communication. Highly significant differences in AVPR1a haplotype frequencies (RS1 and RS3), especially when conditional on both SLC6A4 polymorphisms (HTTLPR and VNTR), were observed between dancers and athletes using the UNPHASED program package (Cocaphase: likelihood ratio test [LRS] = 89.23, p = 0.000044). Similar results were obtained when dancers were compared to nondancers/nonathletes (Cocaphase: LRS = 92.76, p = 0.000024). These results were confirmed using a robust family-based test (Tdtphase: LRS = 46.64, p = 0.010). Association was also observed between Tellegen Absorption Scale scores and AVPR1a (Qtdtphase: global chi-square = 26.53, p = 0.047), SLC6A4 haplotypes (Qtdtphase: chi-square = 2.363, p = 0.018), and AVPR1a conditional on SCL6A4 (Tdtphase: LRS = 250.44, p = 0.011). Similarly, significant association was observed between Tridimensional Personality Questionnaire Reward Dependence scores and AVPR1a RS1 (chi-square = 20.16, p = 0.01). Two-locus analysis (RS1 and RS3 conditional on HTTLPR and VNTR) was highly significant (LRS = 162.95, p = 0.001). Promoter repeat regions in the AVPR1a gene have been robustly demonstrated to play a role in molding a range of social behaviors in many vertebrates and, more recently, in humans. Additionally, serotonergic neurotransmission in some human studies appears to mediate human religious and spiritual experiences. We therefore hypothesize that the association between AVPR1a and SLC6A4 reflects the social communication, courtship, and spiritual facets of the dancing phenotype rather than other aspects of this complex phenotype, such as sensorimotor integration

Using GPS-enabled cell phones to track the travel patterns of adolescents

<p>Abstract</p> <p>Background</p> <p>Few tools exist to directly measure the microsocial and physical environments of adolescents in circumstances where participatory observation is not practical or ethical. Yet measuring these environments is important as they are significantly associated with adolescent health-risk. For example, health-related behaviors such as cigarette smoking often occur in specific places where smoking may be relatively surreptitious.</p> <p>Results</p> <p>We assessed the feasibility of using GPS-enabled cell phones to track adolescent travel patterns and gather daily diary data. We enrolled 15 adolescent women from a clinic-based setting and asked them to carry the phones for 1 week. We found that these phones can accurately and reliably track participant locations, as well as record diary information on adolescent behaviors. Participants had variable paths extending beyond their immediate neighborhoods, and denied that GPS-tracking influenced their activity.</p> <p>Conclusion</p> <p>GPS-enabled cell phones offer a feasible and, in many ways, ideal modality of monitoring the location and travel patterns of adolescents. In addition, cell phones allow space- and time-specific interaction, probing, and intervention which significantly extends both research and health promotion beyond a clinical setting. Future studies can employ GPS-enabled cell phones to better understand adolescent environments, how they are associated with health-risk behaviors, and perhaps intervene to change health behavior.</p

On the evolution of the tymbalian tymbal organ: Comment on “Planthopper bugs use a fast, cyclic elastic recoil mechanism for effective vibrational communication at small body size” by Davranoglou et al. 2019

In ihrer kürzlich erschienenen Arbeit (Davranoglou et al. 2019) untersuchten die Autoren an lebenden Exemplaren von Agalmatium bilobium (Issidae) mit modernsten Methoden (microCT) die Interaktionen zwischen Muskulatur und bestimmten Anteilen des Exoskeletts zur Vibrationserzeugung und beschreiben deren biomechanische Grundlage. Auf der Basis des morphologischen Vergleichs mit Museumsmaterial von Vertretern der meisten Taxa der Fulgoromorpha (Spitzkopfzikaden) im Familienrang postulieren Davranoglou et al. (2019), ein „neues und bisher übersehenes“ Organ entdeckt zu haben, das sie als „snapping organ“ bezeichnen und als charakteristisch für die Fulgoromorpha (mit Ausnahme der Delphacidae) interpretieren. Wir sehen diese Ergebnisse aus folgenden Gründen kritisch: 1. In ihrer umfassenden Übersicht zu den vibrationserzeugenden Organen der Hemiptera stellten Wessel et al. (2014) die Hypothese auf, dass sich alle bisher bekannten Strukturen zur Schall- und Vibrationserzeugung auf ein Organ zurückführen lassen, das mit hoher Wahrscheinlichkeit bei der Stammart aller Hemipteren oberhalb der Sternorrhyncha vorhanden war, und eine Synapomorphie dieses Taxons, der sog. Tymbalia (Wessel et al. 2014), darstellt. Da aufgrund der morphologischen Disparität des Organs in den einzelnen Taxa die Homologieverhältnisse schwierig zu beurteilen sind, stellten Wessel et al. (2014) Kriterien für das „Tymbal der Tymbalia“ auf. Das sogenannte „snapping organ“ erfüllt alle Kriterien dieses Tymbal-Organes. Die Einführung eines neuen Begriffes für eine bestimmte Struktur in einer langen und komplexen Kette evolutionärer Transformationen ist daher unnötig, wenn nicht sogar irreführend. Wir empfehlen daher dringend, in zukünftigen Arbeiten den Begriff „tymbalian tymbal organ with a snapping mechanism“ zu verwenden. 2. Die Grundannahme von Davranoglou et al. (2019), dass – im Gegensatz zum neu entdeckten „snapping organ“ der Fulgoromorpha – allen Cicadomorpha ein „tymbal-ähnliches Or-gan“ gemeinsam sei, ist zu stark vereinfacht und vernachlässigt die enorme Vielfalt der Ausprägungen des Tymbals bei Nicht-Singzikaden innerhalb der Cicadomorpha. In Anbetracht der verfügbaren Studien scheint es daher zweifelhaft, dass sich die vibrationserzeugenden Strukturen dreimal unabhängig voneinander entwickelt haben sollen, wie es die phylogenetische Interpretation bei Davranoglou et al. (2019: Abb. 3) suggeriert

Strengthening and stretching for rheumatoid arthritis of the hand (SARAH). A randomised controlled trial and economic evaluation

Study registration: Current Controlled Trials ISRCTN 89936343.Background - The effectiveness of exercise for improving hand and wrist function in people with rheumatoid arthritis (RA) is uncertain. Objectives - The study aims were (1) to estimate the clinical effectiveness and cost-effectiveness of adding an optimised exercise programme for hands and upper limbs to standard care for patients with RA; and (2) to qualitatively describe the experience of participants in the trial with a particular emphasis on acceptability of the intervention, exercise behaviours and reasons for adherence/non-adherence.This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 19. See the NIHR Journals Library website for further project information. This report has been developed in association with the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford and the NIHR Biomedical Research Unit Funding Scheme. This project benefited from facilities funded through Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform, with support from Advantage West Midlands

The JWST Early-Release Science Program for Direct Observations of Exoplanetary Systems Ii: A 1 To 20 Μm Spectrum of the Planetary-Mass Companion Vhs 1256-1257 B

We present the highest fidelity spectrum to date of a planetary-mass object. VHS 1256 b is a (∼8″, a = 150 au), young, planetary-mass companion that shares photometric colors and spectroscopic features with the directly imaged exoplanets HR 8799c, d, and e. As an L-to-T transition object, VHS 1256 b exists along the region of the color-magnitude diagram where substellar atmospheres transition from cloudy to clear. We observed VHS 1256 b with JWST\u27s NIRSpec IFU and MIRI MRS modes for coverage from 1 to 20 μm at resolutions of ∼1000-3700. Water, methane, carbon monoxide, carbon dioxide, sodium, and potassium are observed in several portions of the JWST spectrum based on comparisons from template brown dwarf spectra, molecular opacities, and atmospheric models. The spectral shape of VHS 1256 b is influenced by disequilibrium chemistry and clouds. We directly detect silicate clouds, the first such detection reported for a planetary-mass companion

The JWST Early Release Science Program for Direct Observations of Exoplanetary Systems IV: NIRISS Aperture Masking Interferometry Performance and Lessons Learned

We present a performance analysis for the aperture masking interferometry (AMI) mode on board the James Webb Space Telescope Near Infrared Imager and Slitless Spectrograph (JWST/NIRISS). Thanks to self-calibrating observables, AMI accesses inner working angles down to and even within the classical diffraction limit. The scientific potential of this mode has recently been demonstrated by the Early Release Science (ERS) 1386 program with a deep search for close-in companions in the HIP 65426 exoplanetary system. As part of ERS 1386, we use the same dataset to explore the random, static, and calibration errors of NIRISS AMI observables. We compare the observed noise properties and achievable contrast to theoretical predictions. We explore possible sources of calibration errors, and show that differences in charge migration between the observations of HIP 65426 and point-spread function calibration stars can account for the achieved contrast curves. Lastly, we use self-calibration tests to demonstrate that with adequate calibration, NIRISS AMI can reach contrast levels of $\sim9-10$ mag. These tests lead us to observation planning recommendations and strongly motivate future studies aimed at producing sophisticated calibration strategies taking these systematic effects into account. This will unlock the unprecedented capabilities of JWST/NIRISS AMI, with sensitivity to significantly colder, lower mass exoplanets than ground-based setups at orbital separations inaccessible to JWST coronagraphy.Comment: 20 pages, 12 figures, submitted to AAS Journal

The \textit{JWST} Early Release Science Program for Direct Observations of Exoplanetary Systems III: Aperture Masking Interferometric Observations of the star HIP\,65426 at 3.8 μm\boldsymbol{3.8\,\rm{\mu m}}

We present aperture masking interferometry (AMI) observations of the star HIP 65426 at $3.8\,\rm{\mu m}$ as a part of the \textit{JWST} Direct Imaging Early Release Science (ERS) program obtained using the Near Infrared Imager and Slitless Spectrograph (NIRISS) instrument. This mode provides access to very small inner working angles (even separations slightly below the Michelson limit of ${}0.5\lambda/D$ for an interferometer), which are inaccessible with the classical inner working angles of the \textit{JWST} coronagraphs. When combined with \textit{JWST}'s unprecedented infrared sensitivity, this mode has the potential to probe a new portion of parameter space across a wide array of astronomical observations. Using this mode, we are able to achieve a contrast of $\Delta m_{F380M}{\sim }7.8$\,mag relative to the host star at a separation of {\sim}0.07\arcsec but detect no additional companions interior to the known companion HIP\,65426\,b. Our observations thus rule out companions more massive than 10{-}12\,\rm{M\textsubscript{Jup}} at separations ${\sim}10{-}20\,\rm{au}$ from HIP\,65426, a region out of reach of ground or space-based coronagraphic imaging. These observations confirm that the AMI mode on \textit{JWST} is sensitive to planetary mass companions orbiting at the water frost line, even for more distant stars at $\sim$100\,pc. This result will allow the planning and successful execution of future observations to probe the inner regions of nearby stellar systems, opening essentially unexplored parameter space.Comment: 15 pages, 9 figures, submitted to ApJ Letter