Assessing the use of social media in physician assistant education.

Objectives: This study aims to assess physician assistant (PA) students\u27 experiences with social media (SM) as a part of their medical education. Methods: The study is split into two phases: Phase 1- A cross-sectional survey emailed to all PA students at four PA school campuses to assess students\u27 prior SM experiences (226 responses, 71.1% response rate); and Phase 2- Inclusion of SM educational resources, via Twitter, within lectures performed at two PA schools. A phase-2 survey assessed students\u27 opinions of educational SM (50 responses, 59.5% response rate) and SM usage was tracked. Results: The phase-1 survey respondents indicated that 97.3% (n=220) use social media; often used as a part of their education, 65% (n=147) informally and 2.7% (n=6) formally incorporated. Students most commonly use Facebook, YouTube, and Instagram, but rarely use Twitter. Currently using SM for medical education was significantly associated with predicting that future PA education will formally include SM [r Conclusions: Many PA students are currently using various forms of social media to augment their education. Most PA students support formal incorporation of social media into their education. PA educators should consider using our data and methods of social media inclusion when designing curricula and while clinically precepting PA students

Does tailoring instructional style to a medical student\u27s self-perceived learning style improve performance when teaching intravenous catheter placement? A randomized controlled study.

BACKGROUND: Students may have different learning styles. It is unclear, however, whether tailoring instructional methods for a student\u27s preferred learning style improves educational outcomes when teaching procedures. The authors sought to examine whether teaching to a student\u27s self-perceived learning style improved the acquisition of intravenous (IV) catheter placement skills. The authors hypothesized that matching a medical student\u27s preferred learning style with the instructor\u27s teaching style would increase the success of placing an IV catheter. METHODS: Using the VARK model (i.e., visual [V], auditory [A], read/write [R] and kinesthetic [K]), third-year medical students reported their self-perceived learning style and were subsequently randomized to instructors who were trained to teach according to a specific learning format (i.e., visual, auditory). Success was gauged by: 1) the placement of an IV on the first attempt and 2) the number of attempts made until an IV line was successfully placed. RESULTS: The average number of attempts in the matched learning style group was 1.53, compared to 1.64 in the unmatched learning style group; however, results were not statistically significant. Both matched and unmatched groups achieved a similar success rate (57 and 58 %, respectively). Additionally, a comparison of success between the unmatched and matched students within each learning style modality yielded no statistical significance. CONCLUSIONS: Results suggest that providing procedural instruction that is congruent with a student\u27s self-perceived learning style does not appear to improve outcomes when instructing students on IV catheter placement

DIRK Schemes with High Weak Stage Order

Runge-Kutta time-stepping methods in general suffer from order reduction: the observed order of convergence may be less than the formal order when applied to certain stiff problems. Order reduction can be avoided by using methods with high stage order. However, diagonally-implicit Runge-Kutta (DIRK) schemes are limited to low stage order. In this paper we explore a weak stage order criterion, which for initial boundary value problems also serves to avoid order reduction, and which is compatible with a DIRK structure. We provide specific DIRK schemes of weak stage order up to 3, and demonstrate their performance in various examples.Comment: 10 pages, 5 figure

On the use of Li isotopes as a proxy for water–rock interaction in fractured crystalline rocks: a case study from the Gotthard rail base tunnel

We present Li isotope measurements of groundwater samples collected during drilling of the 57 km long Gotthard rail base tunnel in Switzerland, to explore the use of Li isotope measurements for tracking water–rock interactions in fractured crystalline rocks at temperatures of up to 43 °C. The 17 groundwater samples originate from water-conducting fractures within two specific crystalline rock units, which are characterized by a similar rock mineralogy, but significantly different fluid composition. In particular, the aqueous Li concentrations observed in samples from the two units vary from 1–4 mg/L to 0.01–0.02 mg/L. Whereas δ7Li values from the unit with high Li concentrations are basically constant (δ7Li = 8.5–9.1‰), prominent variations are recorded for the samples from the unit with low Li concentrations (δ7Li = 10–41‰). This observation demonstrates that Li isotope fractionation can be highly sensitive to aqueous Li concentrations. Moreover, δ7Li values from the unit with low Li concentrations correlate well with reaction progress parameters such as pH and [Li]/[Na] ratios, suggesting that δ7Li values are mainly controlled by the residence time of the fracture groundwater. Consequently, 1D reactive transport modeling was performed to simulate mineral reactions and associated Li isotope fractionation along a water-conducting fracture system using the code TOUGHREACT. Modeling results confirm the residence time hypothesis and demonstrate that the absence of δ7Li variation at high Li concentrations can be well explained by limitation of the amount of Li that is incorporated into secondary minerals. Modeling results also suggest that Li uptake by kaolinite forms the key process to cause Li isotope fractionation in the investigated alkaline system (pH >9), and that under slow flow conditions (<10 m/year), this process is associated with a very large Li isotope fractionation factor (ε ≈ −50‰). Moreover, our simulations demonstrate that for simple and well-defined systems with known residence times and low Li concentrations, δ7Li values may help to quantify mineral reaction rates if more thermodynamic data about the temperature-dependent incorporation of Li in secondary minerals as well as corresponding fractionation factors become available in the future. In conclusion, δ7Li values may be a powerful tool to track water–rock interaction in fractured crystalline rocks at temperature higher than those at the Earth’s surface, although their use is restricted to low Li concentrations and well defined flow systems

Telehealth Benefits in Rural Areas: Occupational Therapy

This paper focuses on the efficacy of occupational-based interventions administered via telehealth within a rural-dwelling adult (18 years and older) population with mental health conditions. The main factors to consider in this scenario are the mental health services in rural areas, the features of the rural population, and the role of occupational therapy (OT) and telehealth in rural mental health. The Occupational Therapy Practice Framework defined health management as “activities related to developing, managing, and maintaining health and wellness routines, including self-management, with the goal of improving or maintaining health to support participation and other occupation” (AOTA, 2020, p.32)

Brief compression-only cardiopulmonary resuscitation training video and simulation with homemade mannequin improves CPR skills.

BACKGROUND: Cardiopulmonary resuscitation (CPR) training has traditionally involved classroom-based courses or, more recently, home-based video self-instruction. These methods typically require preparation and purchase fee; which can dissuade many potential bystanders from receiving training. This study aimed to evaluate the effectiveness of teaching compression-only CPR to previously untrained individuals using our 6-min online CPR training video and skills practice on a homemade mannequin, reproduced by viewers with commonly available items (towel, toilet paper roll, t-shirt). METHODS: Participants viewed the training video and practiced with the homemade mannequin. This was a parallel-design study with pre and post training evaluations of CPR skills (compression rate, depth, hand position, release), and hands-off time (time without compressions). CPR skills were evaluated using a sensor-equipped mannequin and two blinded CPR experts observed testing of participants. RESULTS: Twenty-four participants were included: 12 never-trained and 12 currently certified in CPR. Comparing pre and post training, the never-trained group had improvements in average compression rate per minute (64.3 to 103.9, p = 0.006), compressions with correct hand position in 1 min (8.3 to 54.3, p = 0.002), and correct compression release in 1 min (21.2 to 76.3, p \u3c 0.001). The CPR-certified group had adequate pre and post-test compression rates (\u3e100/min), but an improved number of compressions with correct release (53.5 to 94.7, p \u3c 0.001). Both groups had significantly reduced hands-off time after training. Achieving adequate compression depths (\u3e50 mm) remained problematic in both groups. Comparisons made between groups indicated significant improvements in compression depth, hand position, and hands-off time in never-trained compared to CPR-certified participants. Inter-rater agreement values were also calculated between the CPR experts and sensor-equipped mannequin. CONCLUSIONS: A brief internet-based video coupled with skill practice on a homemade mannequin improved compression-only CPR skills, especially in the previously untrained participants. This training method allows for widespread compression-only CPR training with a tactile learning component, without fees or advance preparation

Chemical Disaster Preparedness for Hospitals and Emergency Departments

Preparing to evaluate and treat victims of a chemical exposure incident is one aspect of hospital disaster preparedness. Past chemical disasters, including terrorist attacks and industrial or transit accidents, have highlighted the need for hospital planning, preparation, and training. Emergency department and hospital staff members must be familiar with their facility-specific protocols and be trained for their individual roles during these incidents. This article provides a brief review of the requirements and guidelines related to chemical disaster response from a healthcare perspective. Resources for training and the evaluation of chemically contaminated patients are discussed. Decontamination procedures, including pre-hospital and hospital-based decontamination of ambulatory, non-ambulatory, and at-risk patients are also reviewed. Physicians and clinicians, especially in the emergency department, must be familiar with methods of evaluating chemical exposures, identifying substances, recognizing toxidromes, ensuring appropriate personal protective equipment (PPE) use, performing decontamination, and initiating treatments for life-threatening conditions. By understanding the guidelines and resources available, clinicians will be better equipped to safely evaluate and treat chemically exposed or contaminated patients

On the use of Li isotopes as a proxy for water–rock interaction in fractured crystalline rocks: A case study from the Gotthard rail base tunnel

We present Li isotope measurements of groundwater samples collected during drilling of the 57 km long Gotthard rail base tunnel in Switzerland, to explore the use of Li isotope measurements for tracking water–rock interactions in fractured crystalline rocks at temperatures of up to 43 °C. The 17 groundwater samples originate from water-conducting fractures within two specific crystalline rock units, which are characterized by a similar rock mineralogy, but significantly different fluid composition. In particular, the aqueous Li concentrations observed in samples from the two units vary from 1–4 mg/L to 0.01–0.02 mg/L. Whereas δ7Li values from the unit with high Li concentrations are basically constant (δ7Li = 8.5–9.1‰), prominent variations are recorded for the samples from the unit with low Li concentrations (δ7Li = 10–41‰). This observation demonstrates that Li isotope fractionation can be highly sensitive to aqueous Li concentrations. Moreover, δ7Li values from the unit with low Li concentrations correlate well with reaction progress parameters such as pH and [Li]/[Na] ratios, suggesting that δ7Li values are mainly controlled by the residence time of the fracture groundwater. Consequently, 1D reactive transport modeling was performed to simulate mineral reactions and associated Li isotope fractionation along a water-conducting fracture system using the code TOUGHREACT. Modeling results confirm the residence time hypothesis and demonstrate that the absence of δ7Li variation at high Li concentrations can be well explained by limitation of the amount of Li that is incorporated into secondary minerals. Modeling results also suggest that Li uptake by kaolinite forms the key process to cause Li isotope fractionation in the investigated alkaline system (pH >9), and that under slow flow conditions (<10 m/year), this process is associated with a very large Li isotope fractionation factor (ε ≈ −50‰). Moreover, our simulations demonstrate that for simple and well-defined systems with known residence times and low Li concentrations, δ7Li values may help to quantify mineral reaction rates if more thermodynamic data about the temperature-dependent incorporation of Li in secondary minerals as well as corresponding fractionation factors become available in the future. In conclusion, δ7Li values may be a powerful tool to track water–rock interaction in fractured crystalline rocks at temperature higher than those at the Earth’s surface, although their use is restricted to low Li concentrations and well defined flow systems