Teaching procedural skills to medical students: a pilot procedural skills lab

Background: Medical students have limited confidence in performing procedural skills. A pilot study was conducted to evaluate the effect of a multifaceted Procedural Skills Lab (PSL) on the confidence of medical students to perform procedural skills. Methods: Twelve 2ndyear medical students were randomly selected to participate in a pilot PSL. The PSL students met with an instructor for 2 h once a week for 4 weeks. Students participated in a flipped classroom and spaced education program before laboratory sessions that included a cadaver laboratory. Procedural skills included a focused assessment with sonography in trauma (FAST) scan, cardiac echocardiogram, lumbar puncture, arthrocentesis, and insertion of intraosseous and intravenous catheters. Students in the PSL were asked to rank their confidence in performing procedural skills before and after completion of the laboratory sessions (Wilcoxon ranked-sum test). A web-based questionnaire was also emailed to all 2ndyear medical students to establish a baseline frequency for observing, performing, and confidence performing procedural skills (Mann–Whitney U-test). Results: Fifty-nine percent (n = 106) of 180 2ndyear medical students (n = 12 PSL students [treatment group], n = 94 [control group]) completed the survey. Frequency of observation, performance, and confidence in performing procedural skills was similar between the control and treatment groups at baseline. There was an increased confidence level (p < 0.001) for performing all procedural skills for the treatment group after completion of the PSL. Discussion: An innovative PSL may increase students' confidence to perform procedural skills. Future studies will examine competency after a PSL

The treatment ambassador program: a highly acceptable and feasible community-based peer intervention for South Africans living with HIV who delay or discontinue antiretroviral therapy

We conducted a novel pilot randomized controlled trial of the Treatment Ambassador Program (TAP), an 8-session, peerbased, behavioral intervention for people with HIV (PWH) in South Africa not on antiretroviral therapy (ART). PWH (43 intervention, 41 controls) completed baseline, 3- and 6-month assessments. TAP was highly feasible (90% completion), with peer counselors demonstrating good intervention fdelity. Post-intervention interviews showed high acceptability of TAP and counselors, who supported autonomy, assisted with clinical navigation, and provided psychosocial support. Intentionto-treat analyses indicated increased ART initiation by 3 months in the intervention vs. control arm (12.2% [5/41] vs. 2.3% [1/43], Fisher exact p-value=0.105; Cohen’s h=0.41). Among those previously on ART (of for>6 months), 33.3% initiated ART by 3 months in the intervention vs. 14.3% in the control arm (Cohen’s h=0.45). Results suggest that TAP was highly acceptable and feasible among PWH not on ART

Automated voxel-wise brain DTI analysis of fitness and aging

Diffusion Tensor Imaging (DTI) has become a widely used MR modality to investigate white matter integrity in the brain. This paper presents the application of an automated method for voxel-wise group comparisons of DTI images in a study of fitness and aging. The automated processing method consists of 3 steps: 1) preprocessing including image format converting, image quality control, eddy-current and motion artifact correction, skull stripping and tensor image estimation, 2) study-specific unbiased DTI atlas computation via diffeomorphic fluid-based and demons deformable registration and 3) voxel-wise statistical analysis via heterogeneous linear regression and a wild bootstrap technique for correcting for multiple comparisons. Our results show that this fully automated method is suitable for voxel-wise group DTI analysis. Furthermore, in older adults, the results suggest a strong link between reduced fractional anisotropy (FA) values, fitness and aging

Embedding the Pentagon

The Pentagon Model is an explicit supersymmetric extension of the Standard Model, which involves a new strongly-interacting SU(5) gauge theory at TeV-scale energies. We show that the Pentagon can be embedded into an SU(5) x SU(5) x SU(5) gauge group at the GUT scale. The doublet-triplet splitting problem, and proton decay compatible with experimental bounds, can be successfully addressed in this context. The simplest approach fails to provide masses for the lighter two generations of quarks and leptons; however, this problem can be solved by the addition of a pair of antisymmetric tensor fields and an axion.Comment: 39 page

How Low Is Too Low? Postpartum Hemorrhage Risk among Women with Thrombocytopenia

Objective To estimate the association between severity of thrombocytopenia and postpartum hemorrhage. Study Design We performed a secondary analysis of a prospective cohort of women delivering by cesarean or vaginal birth after cesarean conducted by the National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Unit. Women delivering ≥ 20 weeks with platelets < 400,000/mL were included. Thrombocytopenia was defined as predelivery platelets of < 150,000/mL. Primary outcomes were (1) laboratory evidence of hemorrhage, defined as a decrease in hemoglobin ≥ 4 mg/dL and (2) clinical evidence of hemorrhage, a composite of atony, transfusion, coagulopathy, hysterectomy, laparotomy, or intensive care unit admission. Odds ratios were calculated for primary outcomes using thrombocytopenia as a dichotomous and ordinal variable. Results A total of 54,597 women were included; 5,611 (10.3%) had antepartum thrombocytopenia, 1,976 (3.6%) women had laboratory evidence of hemorrhage, and 3,862 (7.1%) had clinical evidence of hemorrhage. Thrombocytopenia was associated with both laboratory evidence of hemorrhage (adjusted odds ratio [aOR]: 1.60, 95% CI: 1.38-1.86) and clinical evidence of hemorrhage (aOR: 1.68, 95% CI: 1.52-1.83). The odds of laboratory and clinical evidence of hemorrhage increased incrementally with severity of thrombocytopenia. Conclusion Thrombocytopenia is associated with both laboratory and clinical evidence of hemorrhage; risk increases dramatically as platelet count decreases

Traveling length and minimal traveling time for flow through percolation networks with long-range spatial correlations

We study the distributions of traveling length l and minimal traveling time t through two-dimensional percolation porous media characterized by long-range spatial correlations. We model the dynamics of fluid displacement by the convective movement of tracer particles driven by a pressure difference between two fixed sites (''wells'') separated by Euclidean distance r. For strongly correlated pore networks at criticality, we find that the probability distribution functions P(l) and P(t) follow the same scaling Ansatz originally proposed for the uncorrelated case, but with quite different scaling exponents. We relate these changes in dynamical behavior to the main morphological difference between correlated and uncorrelated clusters, namely, the compactness of their backbones. Our simulations reveal that the dynamical scaling exponents for correlated geometries take values intermediate between the uncorrelated and homogeneous limiting cases

Constraints on the Local Sources of Ultra High-Energy Cosmic Rays

Ultra high-energy cosmic rays (UHECRs) are believed to be protons accelerated in magnetized plasma outflows of extra-Galactic sources. The acceleration of protons to ~10^{20} eV requires a source power L>10^{47} erg/s. The absence of steady sources of sufficient power within the GZK horizon of 100 Mpc, implies that UHECR sources are transient. We show that UHECR "flares" should be accompanied by strong X-ray and gamma-ray emission, and that X-ray and gamma-ray surveys constrain flares which last less than a decade to satisfy at least one of the following conditions: (i) L>10^{50} erg/s; (ii) the power carried by accelerated electrons is lower by a factor >10^2 than the power carried by magnetic fields or by >10^3 than the power in accelerated protons; or (iii) the sources exist only at low redshifts, z<<1. The implausibility of requirements (ii) and (iii) argue in favor of transient sources with L>10^{50} erg/s.Comment: 7 pages, 1 figure, submitted to JCA

A genomic prediction model for racecourse starts in the Thoroughbred horse

Durability traits in Thoroughbred horses are heritable, economically valuable and may affect horse welfare. The aims of this study were to test the hypotheses that (i) durability traits are heritable and (ii) genetic data may be used to predict a horse's potential to have a racecourse start. Heritability for the phenotype ‘number of 2‐ and 3‐year‐old starts’ was estimated to be urn:x-wiley:02689146:media:age12798:age12798-math-0001 = 0.11 ± 0.02 (n = 4499). A genome‐wide association study identified SNP contributions to the trait. The neurotrimin (NTM), opioid‐binding protein/cell adhesion molecule like (OPCML) and prolylcarboxypeptidase (PRCP) genes were identified as candidate genes associated with the trait. NTM functions in brain development and has been shown to have been selected during the domestication of the horse. PRCP is an established expression quantitative trait locus involved in the interaction between voluntary exercise and body composition in mice. We hypothesise that variation at these loci contributes to the motivation of the horse to exercise, which may influence its response to the demands of the training and racing environment. A random forest with mixed effects (RFME) model identified a set of SNPs that contributed to 24.7% of the heritable variation in the trait. In an independent validation set (n = 528 horses), the cohort with high genetic potential for a racecourse start had significantly fewer unraced horses (16% unraced) than did low (27% unraced) potential horses and had more favourable race outcomes among those that raced. Therefore, the information from SNPs included in the model may be used to predict horses with a greater chance of a racecourse start

Development and validation of a radial variable geometry turbine model for transient pulsating flow applications

This paper presents the development and validation of a one-dimensional radial turbine model able to be used in automotive turbocharger simulations. The model has been validated using results from a numerical 3D CFD simulation of stationary and pulsating flow in a variable geometry radial turbine. As the CFD analysis showed, the main non-quasi-steady behavior of the turbine is due to the volute geometry, so special care was taken in order to properly model it while maintaining low computational costs. The flow in the volute has been decomposed in its radial and azimuthal direction. The azimuthal flow corresponds to the flow moving along the volute, while the radial flow is computed by coupling its flow with a stator model. Although the stator caused fewer accumulation effects than the volute, a small accumulation model has been used for it, which also allows to compute the evolution of the flow inside the turbine with lower costs. The flow in the moving rotor can be considered quasi-steady, so a zero-dimensional model for the rotor has been developed. Several losses models where implemented for both the stator and the rotor. The results show good agreement with the CFD computations. 2014 Elsevier Ltd. All rights reserved.The authors are indebted to the Spanish Ministerio de Economia y Competitividad through Project TRA 2010-16205.Galindo, J.; Tiseira Izaguirre, AO.; Fajardo, P.; García-Cuevas González, LM. (2014). Development and validation of a radial variable geometry turbine model for transient pulsating flow applications. Energy Conversion and Management. 85:190-203. https://doi.org/10.1016/j.enconman.2014.05.072S1902038

Exploring nu signals in dark matter detectors

We investigate standard and non-standard solar neutrino signals in direct dark matter detection experiments. It is well known that even without new physics, scattering of solar neutrinos on nuclei or electrons is an irreducible background for direct dark matter searches, once these experiments each the ton scale. Here, we entertain the possibility that neutrino interactions are enhanced by new physics, such as new light force carriers (for instance a "dark photon") or neutrino magnetic moments. We consider models with only the three standard neutrino flavors, as well as scenarios with extra sterile neutrinos. We find that low-energy neutrino--electron and neutrino--nucleus scattering rates can be enhanced by several orders of magnitude, potentially enough to explain the event excesses observed in CoGeNT and CRESST. We also investigate temporal modulation in these neutrino signals, which can arise from geometric effects, oscillation physics, non-standard neutrino energy loss, and direction-dependent detection efficiencies. We emphasize that, in addition to providing potential explanations for existing signals, models featuring new physics in the neutrino sector can also be very relevant to future dark matter searches, where, on the one hand, they can be probed and constrained, but on the other hand, their signatures could also be confused with dark matter signals.Comment: 38 pages, 8 figures, 1 table; v3: eq 3 and nuclear recoil plots corrected, footnote added, conclusions unchange