Using area health education centers to promote interest in rural practice

Introduction: In the USA, area health education centers (AHECs) work to recruit and educate students to serve in medically underserved communities, primary care, and rural settings. One important aspect of their work is connecting students with rural clinical experiences. Within these experiences, AHECs incorporate a community health/socioeconomic experience within the family medicine clerkship that may not be as prevalent in the standard family medicine clerkship experiences. The purpose of the study was to assess the relationship between AHEC-sponsored family medicine clerkships with a self-reported intent to practice in a rural setting upon graduation. Methods: The study compared third-year medical students with the Indiana University School of Medicine, which participated in AHEC-sponsored family medicine clerkships to the standard family medicine clerkship. Following the 4-week clerkship, students were asked to report their intent to work in a rural setting using a five-point Likert scale. A χ2 test was used to determine the association of AHEC sponsorship, clerkship site location (rural/urban) and intent to practice in a rural setting. Results: The study consisted of 587 students. There was a statistically significant association between self-reported intent and rural clerkship site, χ2 (1, N=587)=6.542, p=0.01. Furthermore, 21.6% (n=25) of students with a rural clerkship experience reported a greater intent compared to 12.3% (n=58) of students with non-rural clerkship experience. Conclusions: The study confirmed a significantly positive association between participation in medical clerkship experiences in a rural primary care setting and the intent to practice in a rural setting upon graduation. The results also support the potential value-added benefits through academic–community partnerships with AHECs, family medical and other primary care specialty clerkship programs may perhaps succeed in increasing student interest in pursuing a practice serving in rural communities upon graduation

The Jet-Driven Outflow In The Radio Galaxy SDSS J1517+3353: Implications For Double-Peaked Narrow-Line Active Galactic Nucleus

We report on the study of an intriguing active galaxy that was selected as a potential multiple supermassive black hole merger in the early-type host SDSS J151709.20+335324.7 (z = 0.135) from a complete search for double-peaked [O III] lines from the SDSS spectroscopic quasi-stellar object (QSO) database. Ground-based SDSS imaging reveals two blue structures on either side of the photometric center of the host galaxy, separated from each other by about 5.7 kpc. From a combination of SDSS fiber and Keck/HIRES long-slit spectroscopy, it is demonstrated that, in addition to these two features, a third distinct structure surrounds the nucleus of the host galaxy. All three structures exhibit highly ionized line emission with line ratios characteristic of Seyfert II active galactic nuclei. The analysis of spatially resolved emission-line profiles from the HIRES spectrum reveal three distinct kinematic subcomponents, one at rest and the other two moving at -350 km s(-1) and 500 km s(-1) with respect to the systemic velocity of the host galaxy. A comparison of imaging and spectral data confirm a strong association between the kinematic components and the spatial knots, which implies a highly disturbed and complex active region in this object. A comparative analysis of the broadband positions, colors, kinematics, and spectral properties of the knots in this system lead to two plausible explanations: (1) a multiple active galactic nucleus (AGN) produced due to a massive dry merger, or (2) a very powerful radio jet-driven outflow. Subsequent VLA radio imaging reveals a clear jet aligned with the emission-line gas, confirming the latter explanation. We use the broadband radio measurements to examine the impact of the jet on the interstellar medium of the host galaxy, and find that the energy in the radio lobes can heat a significant fraction of the gas to the virial temperature. Finally, we discuss tests that may help future surveys distinguish between jet-driven kinematics and true black-hole binaries. J1517+3353 is a remarkable laboratory for AGN feedback and warrants deeper follow-up study. In the Appendix, we present high-resolution radio imaging of a second AGN with double-peaked [O III] lines, SDSS J112939.78+605742.6, which shows a sub-arcsecond radio jet. If the double-peaked nature of the narrow lines in radio-loud AGNs are generally due to radio jet interactions, we suggest that extended radio structure should be expected in most of such systems.NSF AST-0507483, AST-0808133University of Texas at AustinAlfred P. Sloan FoundationParticipating InstitutionsNational Aeronautics and Space AdministrationU.S. Department of EnergyJapanese MonbukagakushoMax Planck SocietyAstronom

Modifications to the Aesop's Fable paradigm change New Caledonian crow performances

While humans are able to understand much about causality, it is unclear to what extent non-human animals can do the same. The Aesop's Fable paradigm requires an animal to drop stones into a water-filled tube to bring a floating food reward within reach. Rook, Eurasian jay, and New Caledonian crow performances are similar to those of children under seven years of age when solving this task. However, we know very little about the cognition underpinning these birds' performances. Here, we address several limitations of previous Aesop's Fable studies to gain insight into the causal cognition of New Caledonian crows. Our results provide the first evidence that any non-human animal can solve the U-tube task and can discriminate between water-filled tubes of different volumes. However, our results do not provide support for the hypothesis that these crows can infer the presence of a hidden causal mechanism. They also call into question previous object-discrimination performances. The methodologies outlined here should allow for more powerful comparisons between humans and other animal species and thus help us to determine which aspects of causal cognition are distinct to humans.Publisher PDFPeer reviewe

The Lonely Scroll: The Impact of Social Media on Loneliness in Introverts and Extroverts

This study examined the impact that social media had on feelings of loneliness in introverts and extroverts. Each participant received a survey based off of the NEO Personality Inventory, the UCLA Loneliness Scale and the Internet Behaviors Scale. The survey aimed to assess the relationship between social media and feelings of loneliness on different personality types. Social Media is a prevalent aspect of modern day culture. Therefore, this study aims to teach individuals how to prevent social media from negatively affecting them. The results supported our hypotheses that both loneliness and internet use, as well as, personality type and loneliness are statistically significant

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

Objective: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use. Data Sources: A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesisstimulating agents, and erythropoietin. Study Selection and Data Extraction: All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery patients were evaluated, provided they reported blood transfusion outcomes. Data Synthesis: A total of 9 prospective and retrospective studies and 1 meta-analysis were identified and included. In the preoperative setting, administration of oral iron, IV iron, or ESA alone or in combination to correct underlying anemia led to significantly reduced transfusion rates. Transfusion requirements were generally less with combination therapy (ESA + oral or IV iron). In the short-term perioperative or postoperative period, use of oral or IV iron led to conflicting results, with some reporting a statistically significant reduction in blood transfusions, whereas others reported none. Conclusions: In elective orthopedic surgery, IV or oral iron with or without an ESA may provide benefit in prevention of postoperative anemia and results in blood transfusion reduction without significantly increasing the risk of adverse events. These agents should be considered at the lowest effective dose with emphasis on administration prior to planned surgery

GLP-1 Agonists in Type 1 Diabetes Mellitus: A Review of the Literature

Objective: To review the use of GLP-1 agonists in patients with type 1 diabetes mellitus (T1DM). Data Sources: A search using the MEDLINE database, EMBASE, and Cochrane Database was performed through March 2016 using the search terms glucagon-like peptide 1 (GLP-1) agonists, incretin, liraglutide, exenatide, albiglutide, dulaglutide, type 1 diabetes mellitus. Study Selection and Data Extraction: All English-language trials that examined glycemic end points using GLP- 1 agonists in humans with T1DM were included. Data Synthesis: A total of 9 clinical trials examining the use of GLP-1 agonists in T1DM were identified. On average, hemoglobin A1C (A1C) was lower than baseline, with a maximal lowering of 0.6%. This effect was not significant when tested against a control group, with a relative decrease in A1C of 0.1% to 0.2%. In all trials examined, reported hypoglycemia was low, demonstrating no difference when compared with insulin monotherapy. Weight loss was seen in all trials, with a maximum weight loss of 6.4 kg over 24 weeks. Gastrointestinal adverse effects are potentially limiting, with a significant number of patients in trials reporting nausea. Conclusion: The use of GLP-1 agonists should be considered in T1DM patients who are overweight or obese and not at glycemic goals despite aggressive insulin therapy; however, tolerability of these agents is a potential concern. Liraglutide has the strongest evidence for use and would be the agent of choice for use in overweight or obese adult patients with uncontrolled T1DM

Redefining the performing arts archive

This paper investigates representations of performance and the role of the archive. Notions of record and archive are critically investigated, raising questions about applying traditional archival definitions to the performing arts. Defining the nature of performances is at the root of all difficulties regarding their representation. Performances are live events, so for many people the idea of recording them for posterity is inappropriate. The challenge of creating and curating representations of an ephemeral art form are explored and performance-specific concepts of record and archive are posited. An open model of archives, encouraging multiple representations and allowing for creative reuse and reinterpretation to keep the spirit of the performance alive, is envisaged as the future of the performing arts archive

Identifying Factors Associated with Participation in T1D Support Program for Young Adults

Objective: Type 1 diabetes (T1D) has been shown to have a significant and stressful impact on an individual’s transition into young adulthood. Young adults are often experiencing new levels of independence and decision-making at this time. Insufficient research has been conducted on the use and impact of T1D support programs tailored to young adults in relation to the emotional impacts of the disease, access to programming, and desired outcomes of programs. his study assesses awareness, utilization, and emotional needs of T1D support programs tailored to young adults. Research Design and Methods: A cross-sectional analysis was performed on surveys collected through specific groups on Facebook (n=529). Logistic regression was used to assess factors associated with participation in T1D support programs. Results: Approximately 41% of participants had been involved in a program or activity for young adults. he average age was 24 (range 18-30) with females being overrepresented (85%). Individuals who attended a T1D support program for young adults were more likely to disagree that: 1) their T1D keeps them from having a normal life; 2) they feel their T1D controls their life; 3) they feel their T1D takes up too much mental/physical energy; or 4) they need more peer-to-peer support with T1D. Conclusion: The indings highlight the importance for T1D support programs for young adults and the unique needs of a population with T1D. T1D support programs should be considered in combination with clinical support to better prepare individuals as they transition into young adulthood

Mental template matching is a potential cultural transmission mechanism for New Caledonian crow tool manufacturing traditions

Cumulative cultural evolution occurs when social traditions accumulate improvements over time. In humans cumulative cultural evolution is thought to depend on a unique suite of cognitive abilities, including teaching, language and imitation. Tool-making New Caledonian crows show some hallmarks of cumulative culture; but this claim is contentious, in part because these birds do not appear to imitate. One alternative hypothesis is that crows' tool designs could be culturally transmitted through a process of mental template matching. That is, individuals could use or observe conspecifics' tools, form a mental template of a particular tool design, and then reproduce this in their own manufacture - a process analogous to birdsong learning. Here, we provide the first evidence supporting this hypothesis, by demonstrating that New Caledonian crows have the cognitive capacity for mental template matching. Using a novel manufacture paradigm, crows were first trained to drop paper into a vending machine to retrieve rewards. They later learnt that only items of a particular size (large or small templates) were rewarded. At test, despite being rewarded at random, and with no physical templates present, crows manufactured items that were more similar in size to previously rewarded, than unrewarded, templates. Our results provide the first evidence that this cognitive ability may underpin the transmission of New Caledonian crows' natural tool designs.Tis study was supported by the NZ Marsden fund (RDG), a Rutherford Discovery Fellowship and the 2015 Prime Ministers MacDiarmid Emerging Scientist prize (AHT). SAJ thanks the ERC (Grant Agreement No. 3399933) for funding

Radical Hysterectomy for Early Stage Cervical Cancer: Laparoscopy Versus Laparotomy

Laparoscopic radical hysterectomy appears to be a feasible alternative to laparotomy for early stage cervical cancer with similar surgical outcomes and lessened morbidity