Toward Universal Broadband in Rural Alaska

The TERRA-Southwest project is extending broadband service to 65 communities in the Bristol Bay, Bethel and Yukon-Kuskokwim regions. A stimulus project funded by a combination of grants and loans from the Rural Utilities Service (RUS), TERRA-Southwest has installed a middle-mile network using optical fiber and terrestrial microwave. Last-mile service will be through fixed wireless or interconnection with local telephone networks. The State of Alaska, through its designee Connect Alaska, also received federal stimulus funding from the National Telecommunications and Information Administration (NTIA) for tasks that include support for an Alaska Broadband Task Force “to both formalize a strategic broadband plan for the state of Alaska and coordinate broadband activities across relevant agencies and organizations.” Thus, a study of the impact of the TERRA project in southwest Alaska is both relevant and timely. This first phase provides baseline data on current access to and use of ICTs and Internet connectivity in rural Alaska, and some insights about perceived benefits and potential barriers to adoption of broadband. It is also intended to provide guidance to the State Broadband Task Force in determining how the extension of broadband throughout the state could contribute to education, social services, and economic activities that would enhance Alaska’s future. Results of the research could also be used proactively to develop strategies to encourage broadband adoption, and to identify applications and support needed by users with limited ICT skills.Connect Alaska. The National Telecommunications and Information Administration. General Communications Incorporated.Part 1: An Analysis of Internet Use in Southwest Alaska / Introduction / Previous Studies / Current Connectivity / Analytical Framework and Research Methodology / Demographics / Mobile Phones: Access and Use / Access to the Internet / Internet Useage / Considerations about Internet Service / Interest in Broadband / Sources of News / Comparison with National Data / Internet Use by Businesses and Organizations / What Difference may Broadband make in the Region? / Conclusiongs / Part 2 Literature Review / Reference

Exercise, mood, self-efficacy, and social support as predictors of depressive symptoms in older adults : Direct and interaction effects

Background: Depression is a chronic condition that affects up to 15% of older adults. The healthogenic effects of regular exercise are well established, but it is still unclear which exercise-related variables characterise the antidepressant effects of exercise. Thus, the purpose of this study was to examine the extent to which exercise-related variables (exercise behaviour, exercise-induced mood, exercise self-efficacy, and social support) can predict depressive symptoms in a cohort of community-dwelling older adults. Methods: This study employed a cross-sectional analysis of questionnaire data from a sample of 586 community-dwelling older Australians aged 65 to 96 years old. Participants completed the Center for Epidemiologic Studies Depression Scale, modified CHAMPS Physical Activity Questionnaire for Older Adults, Four-Dimension Mood Scale, Self-Efficacy for Exercise Scale, and Social Provisions Scale - Short Form. Bivariate correlations were performed, and hierarchical multiple regression was subsequently used to test the regression model. Results: Exercise behaviour, exercise-induced mood, exercise self-efficacy, and social support were all negatively associated with depressive symptoms (r = -0.20 to -0.56). When the variables were entered as predictors into the hierarchical multiple regression model, social support was the strongest predictor of depressive symptoms (beta = -0.42), followed by exercise-induced mood (beta = -0.23), and exercise self-efficacy (beta = -0.07). Exercise behaviour did not explain any additional variance in depressive symptoms. A modest interaction effect was also observed between exercise-induced mood and social support. Conclusion: These findings indicate that social support is the strongest predictor of depressive symptomology in community-dwelling older adults, particularly when combined with positive exercise-induced mood states. When addressing the needs of older adults at risk of depression, healthcare professionals should consider the implementation of exercise programmes that are likely to benefit older adults by improving mood, enhancing self-efficacy, and building social support

Clinical Educator and Student Perceptions of iPad™ Technology to Enhance Clinical Supervision: The Electronically-Facilitated Feedback Initiative (EFFI)

Purpose: Growing demands placed upon healthcare systems require more health professionals to be trained. Clinical placement education is an integral component of health professional training, however accommodating increasing numbers of student placements is a challenge for health services. Personal digital assistants such as iPads™ may assist in delivery of clinical education, by facilitating transfer of knowledge and skills from clinical educators to health professional students, however such an initiative has not been formally investigated. The present study sought to explore perceptions of clinical educators and allied health students regarding the impact of an iPad™-based feedback delivery system on student reflection and learning. Methods: A pilot study was performed using iPads™ with specialised software to deliver electronic formative feedback to physiotherapy, occupational therapy and speech pathology students during clinical placements. Students and clinical educators completed a questionnaire exploring advantages and disadvantages of the technology. Results: Nine clinical educators and 14 students participated and completed the survey. Clinical educators largely (n=7, 78%) reported the electronic feedback system was easy to use and 67% (n=6) reported it improved the quality of feedback provided to students. Five (56%) clinical educators thought electronic feedback improved student performance. Most students (n=10, 71%) reported electronic feedback facilitated reflection upon performance, and 64% (n=9) reported improved performance as a result. Disadvantages included poor wireless internet access and software inefficiencies (n=7 [78%] clinical educators, n=7 [50%] students), and difficulties using iPads™ in settings requiring infection control (n=2 [22%] clinical educators). Conclusions: Clinical educators and students perceived electronic feedback as a positive adjunct to student learning on clinical placement, however technological and software interface factors need to be considered for implementation in some settings

Assessment of a Novel Pediatric Resident Simulation Curriculum

Aim: To assess the efficacy of a newly implemented resident simulation curriculum at a medium sized pediatric residency program. Background: Many pediatric residency programs incorporate high-fidelity simulation into their curriculum, but there is limited data discussing the utility/educational impacts of a longitudinal/standardized/multimodal simulation curriculum. Several studies of simulation-based training have employed “self-efficacy” as a barometer for trainee education and performance 1,2,. The level of a person’s self-efficacy can influence their behavior and may be a pivotal factor in performance. We have implemented a newly devised standardized, multimodal resident simulation curriculum and used resident self-efficacy to assess its effectiveness. Methods: Participants were UMass Pediatric and Med/Peds residents. Implementation of our curriculum occurred at the start of the 2016-2017 academic year. Surveys were administered to all residents prior to curriculum implementation and at 6 months post-implementation. They assessed resident self-efficacy with regards to specific technical/procedural skills (i.e. running a code, performing intubation, etc.) and resident confidence in their ability to identify/manage specific pediatric disease presentations (i.e. respiratory failure, tachyarrhythmia, etc.). Data was pooled and averaged for each resident class separately. We predetermined a 10% change in self-efficacy to be a clinically significant difference. Results: 36 of 40 residents completed the initial survey and 31 completed the 6-month follow-up. PGY1 residents reported improved self-efficacy for 4 PALS-related skills and 8 pediatric case presentations. Similarly, PGY2 residents reported improved self-efficacy for 3 PALS-related skills and 6 pediatric case presentations. Conversely, PGY3/4 residents reported no significant change in self-efficacy for any survey question. Conclusions: These results suggest that our newly implemented longitudinal, standardized, multidisciplinary, multi-modal simulation curriculum has significantly improved resident self-efficacy related to core Pediatric Advanced Life-Support (PALS) skills/topics, with the greatest impact affecting our PGY1 class. Further study and curriculum development will attempt to address this issue

Teratoma Generation in the Testis Capsule

Pluripotent stem cells (PSCs) have the unique characteristic that they can differentiate into cells from all three germ layers. This makes them a potentially valuable tool for the treatment of many different diseases. With the advent of induced pluripotent stem cells (iPSCs) and continuing research with human embryonic stem cells (hESCs) there is a need for assays that can demonstrate that a particular cell line is pluripotent. Germline transmission has been the gold standard for demonstrating the pluripotence of mouse embryonic stem cell (mESC) lines1,2,3. Using this assay, researchers can show that a mESC line can make all cell types in the embryo including germ cells4. With the generation of human ESC lines5,6, the appropriate assay to prove pluripotence of these cells was unclear since human ESCs cannot be tested for germline transmission. As a surrogate, the teratoma assay is currently used to demonstrate the pluripotency of human pluripotent stem cells (hPSCs)7,8,9. Though this assay has recently come under scrutiny and new technologies are being actively explored, the teratoma assay is the current gold standard7. In this assay, the cells in question are injected into an immune compromised mouse. If the cells are pluripotent, a teratoma will eventually develop and sections of the tumor will show tissues from all 3 germ layers10. In the teratoma assay, hPSCs can be injected into different areas of the mouse. The most common injection sites include the testis capsule, the kidney capsule, the liver; or into the leg either subcutaneously or intramuscularly11. Here we describe a robust protocol for the generation of teratomas from hPSCs using the testis capsule as the site for tumor growth