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Residency education delivery in the United States has migrated from conventional lectures to alternative educational models that include mini-lectures, small group, and learner lead discussions. As training programs struggle with mandated hours of content, prehospital (EMS) and disaster medicine are given limited focus. While the need for prehospital and disaster medicine education in emergency training is understood, no standard curriculum delivery has been proposed and little research has been done to evaluate the effectiveness of any particular model.
To demonstrate a four-hour multi-modal curriculum that includes lecture based discussions and small group exercises, culminating in an interactive multidisciplinary competition that integrates the previously taught information.
EMS and disaster faculty were surveyed on the previous disaster and prehospital educational day experiences to evaluate course content, level of engagement, and participation by faculty. Based on this feedback, the EMS/Disaster divisions developed a schedule for the four hour EMS and Disaster Day that incorporated vital concepts while addressing the pitfalls previously identified. Sessions included traditional lectures, question and answer sessions, small group exercises, and a tabletop competition. Structured similarly to a strategy board game, the tabletop exercise challenged residents to take into account both medical and ethical considerations during a traditional triage exercise.
Compared to past reviews by emergency medical faculty, residents, and medical students, there was a precipitous increase in satisfaction scores on the part of all participants.
This curriculum deviates from the conventional education model and has been successfully implemented at our 3-year residency program of 66 residents. This EMS and Disaster Day promotes active learning, resident and faculty participation, and retention of important concepts while also fostering relationships between disaster managers and the Department of Emergency Medicine.
On August 25, 2017, Hurricane Harvey made landfall near Corpus Christi, Texas. The ensuing unprecedented flooding throughout the Texas coastal region affected millions of individuals.1 The statewide response in Texas included the sheltering of thousands of individuals at considerable distances from their homes. The Dallas area established large-scale general population sheltering as the number of evacuees to the area began to amass. Historically, the Dallas area is one familiar with “mega-sheltering,” beginning with the response to Hurricane Katrina in 2005.2 Through continued efforts and development, the Dallas area had been readying a plan for the largest general population shelter in Texas. (Disaster Med Public Health Preparedness. 2019;13:33–37)
Lithium was associated with significantly reduced non-suicide mortality in the intent-to-treat cohort over 0–90 days (hazard ratio (HR) = 0.67, 95% CI 0.51–0.87) but not longer. In secondary analyses, a sizeable reduction in mortality was observed during active treatment with lithium across all time periods studied (for example 365-day HR = 0.62, 95% CI 0.45–0.84), but significantly increased risks were observed among patients discontinuing lithium by 180 days (HR = 1.54, 95% CI 1.01–2.37).
Patients initiating lithium had lower non-suicide mortality over 0–90 days than patients initiating valproate and consistently lower non-suicide mortality among patients maintaining treatment, but elevated risk among patients discontinuing treatment by 180 days. Although residual confounding or selection effects cannot be excluded, this study suggests potential benefits to enhancing lithium treatment persistence and the monitoring of patients discontinuing lithium. There is a need for further research.
This article presents results from the first 3 rounds of an international intercomparison of measurements of Δ14CO2 in liter-scale samples of whole air by groups using accelerator mass spectrometry (AMS). The ultimate goal of the intercomparison is to allow the merging of Δ14CO2 data from different groups, with the confidence that differences in the data are geophysical gradients and not artifacts of calibration. Eight groups have participated in at least 1 round of the intercomparison, which has so far included 3 rounds of air distribution between 2007 and 2010. The comparison is intended to be ongoing, so that: a) the community obtains a regular assessment of differences between laboratories; and b) individual laboratories can begin to assess the long-term repeatability of their measurements of the same source air. Air used in the intercomparison was compressed into 2 high-pressure cylinders in 2005 and 2006 at Niwot Ridge, Colorado (USA), with one of the tanks “spiked” with fossil CO2, so that the 2 tanks span the range of Δ14CO2 typically encountered when measuring air from both remote background locations and polluted urban ones. Three groups show interlaboratory comparability within l% for ambient level Δ14CO2. For high CO2/low Δ14CO2 air, 4 laboratories showed comparability within 2%. This approaches the goals set out by the World Meteorological Organization (WMO) CO2 Measurements Experts Group in 2005. One important observation is that single-sample precisions typically reported by the AMS community cannot always explain the observed differences within and between laboratories. This emphasizes the need to use long-term repeatability as a metric for measurement precision, especially in the context of long-term atmospheric monitoring.
We report on the incorporation of molybdenum into tungsten oxide by co-sputtering and its effect on solar-powered photoelectrochemical (PEC) water splitting. Our study shows that Mo incorporation in the bulk of the film (WO3:Mo) results in poor PEC performance when compared with pure WO3, most likely due to defects that trap photo-generated charge carriers. However, when a WO3:Mo/WO3 bilayer electrode is used, a 20% increase of the photocurrent density at 1.6 V versus saturated calomel reference electrode is observed compared with pure WO3. Morphological and microstructural analysis of the WO3:Mo/WO3 bilayer structure reveals that it is formed by coherent growth of the WO3:Mo top layer on the WO3 bottom layer. This effect allows an optimization of the electronic surface structure of the electrode while maintaining good crystallographic properties in the bulk.
Sixty-eight individuals were randomised to either six sessions of imaginal
desensitisation plus motivational interviewing (IDMI) or Gamblers Anonymous.
Individuals assigned to IDMI had significantly greater reductions in
Yale–Brown Obsessive Compulsive Scale Modified for Pathological Gambling
total scores, gambling urges and gambling behaviour. People who failed to
respond to Gamblers Anonymous reported significantly greater reduction in
pathological gambling symptoms following later assignment to IDMI.
Abstinence was achieved by 63.6% during the acute IDMI treatment period.