Core Rotation Research Articles

Influence of undergraduate medical education exposure to cadaveric dissection on choice of surgical specialty: a national survey of Canadian surgical residents.

BackgroundThe number of Canadian Residency Matching Service (CaRMS) applicants ranking surgical specialties as their first choice has declined over the past 20 years; concurrently, there has been a reduction in the number of hours spent teaching undergraduate medical education (UGME) anatomy, particularly with cadaveric dissection. The aim of this study was to determine the factors that most influence selection of a surgical specialty, with specific focus on the impact of UGME anatomy training.MethodsA 36-item cross-sectional survey was designed by experts in medical education and distributed to all current surgical residents in Canada in October 2018. Responses were recorded on a 5-point Likert scale or by means of list ranking. We analyzed univariable outcomes with a t test for continuous outcomes and the χ2 test for dichotomous outcomes.ResultsOf 1493 surgical residents, 228 responded to the survey (response rate 15.3%). Respondents reported experiences on core rotations and elective rotations, and access to a mentor as the most important factors in deciding to pursue a surgical residency. Anatomy training with or without cadaveric dissection was moderately influential in respondents’ first-choice CaRMS discipline (mean Likert scale score 2.97 [standard deviation (SD) 1.34] and 2.87 [SD 1.26], respectively). General surgery residents’ CaRMS applications were more likely to have been influenced by UGME anatomy training than the applications by residents in other surgical specialties (p < 0.001). The impact of UGME anatomy training did not vary between postgraduate years or between male and female residents.ConclusionCanadian surgical residents’ decision to apply to a surgical specialty did not seem to be strongly influenced by their UGME anatomy training, with or without cadaveric dissection, but, rather, by factors such as clinical experience and surgical mentorship. Further evaluation of groups that were more positively affected by their UGME anatomy training is warranted.

How Do Clinical Electives during the Clerkship Year Influence Career Exploration? A Qualitative Study

Problem: Although many students begin medical school with some idea of their specialty interest, up to 80% of these students choose a different specialty by their final year. This pivot tends to happen in the clerkship year, when students are immersed in the clinical environment, gaining a practical understanding of the day-to-day work in different fields. Yet, in this year students have limited experiences with specialties. Clinical electives during the clerkship year may aid students in career development. The authors examined student career exploration through the lens of social cognitive career theory (SCCT). SCCT posits three variables that influence career development: personal goals, self-efficacy, and understanding outcome expectations. With this framework, the authors sought to understand how a program of clinical electives during the clerkship year influences students’ perceptions of their career exploration. We aimed to: (1) describe an innovative clerkship elective program designed for career exploration, and (2) explore how this influenced students’ career exploration using qualitative analysis. Intervention: Beginning in 2018, students at our institution were required to participate in three 2-week clinical electives during their clerkship year, called Clinical Immersive Experiences (CIExes). CIExes were categorized into four different types: apprenticeship, clinical skills building, integrative (multi-disciplinary), or subspecialty. Authors invited fourth year students to participate in interviews (January to March 2019) about how they selected electives and how these electives contributed to their career exploration. Interviews continued until reaching information sufficiency. Authors coded and analyzed transcripts using template analysis. Context: This curricular intervention took place in the context of large-scale curricular redesign. Students began clerkships partway into their second year of medical school. The family and community medicine clerkship, which was previously a 6-week core clerkship, was changed to a longitudinal format, thus freeing up 6 weeks for electives. Other core clerkships included anesthesia (2 weeks), medicine (8 weeks), neurology (4 weeks), obstetrics and gynecology (6 weeks), pediatrics (6 weeks), psychiatry (4 weeks), and surgery (8 weeks). Impact: From 15 student interviews, we identified three major themes. First, CIExes facilitated personalized career exploration. All students felt that at least one elective helped them solidify their decision about a specialty choice. Second, CIExes promoted focused learning and skills development that complemented core rotations. They noted the benefit of positive relationships with supervisors, particularly attendings, during these electives. Third, students highlighted how these electives fostered a positive learning environment and enhanced wellbeing. SCCT clarified how the CIEx program helped students advance their personal goals, self-efficacy, and outcome expectations during a pivotal time in medical school. Lessons Learned: We learned that from the student perspective, the inclusion of clinical electives in the clerkship year benefited students’ career exploration by helping them develop and refine their career goals, increase self-efficacy, and test outcome expectations in a meaningful way as anticipated from SCCT. In addition, we found that CIExes created a positive learning environment that allowed deep relationships to develop in fields of interest and that supported a strong sense of wellbeing. Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1891545

Characteristics of complex interaction between two oppositely-moving laminar buoyant-plumes within slender vertical-channels

The article presents laminar plumes, cellular structures and spatial-waviness in free convective flow within a vertical channel under anti-symmetric heating, and the subtle flow-features during the transition to anti-asymmetry. We perform numerical simulations for a wide range of cross-sectional Grashof numbers (262.4≤ Grb ≤33025), channel aspect ratio (0.0375≤ψ ≤0.1255) and isothermal boundary conditions (anti-asymmetric heating to anti-symmetric heating). The chosen working fluid is air; hence the Prandtl number (Pr) is fixed at 0.715. Certain modified parameters are defined for the present study, such as the channel Grashof number (Gr) and symmetry ratio (εC), to govern the working condition of the channel. The physics of the interaction between oppositely moving wall plumes is studied thoroughly, and the highly sensitive, spatially-oscillatory nature of the flow near the plume interface is shown with the help of velocity and temperature contours. Analytical expressions for the primary velocity and temperature have been derived for the wall plumes for the developed region. Also, the crucial role of the secondary velocity field on the heat and mass transfer across the plume interface and convection cell formation is highlighted, which fails to find much attention in the available literature. Motivated by the flow-features, a novel vorticity-mapping is performed, and the entire flow domain is divided into two regimes, viz. a highly rotational core region and a unidirectional near-wall region, which are separated and illustrated using limiting streamlines. The rotational, stagnant core region seems to expand as Gr increases, resulting in a drop in pumping performance. The Gr is varied by changing both the ψ as well as the hot wall temperature ΘH. The relative effects of these methods on the channel pumping, and thermal performance are studied and an optimum method of Gr variation is proposed for the channel. Finally, the effect of the degree of opposing buoyancy forces is studied by varying the cold wall temperature to attain thermal boundary conditions ranging from anti-asymmetry to anti-symmetry. As the opposing buoyancy increases, the heat transfer becomes more convection dominant near the colder wall and less convection dominant near the hotter wall. Also, the pumping performance seems to be affected adversely, as εC is increased. A peculiar change in the channel performance is also highlighted during the transition to anti-symmetric heating conditions near εC=0.9.

Rotation of the convective core in γ Dor stars measured by dips in period spacings of g modes coupled with inertial modes

ABSTRACT The relation of period spacing (ΔP) versus period (P) of dipole prograde g modes is known to be useful to measure rotation rates in the g-mode cavity of rapidly rotating γ Dor and slowly pulsating B (SPB) stars. In a rapidly rotating star, an inertial mode in the convective core can resonantly couple with g-mode propagative in the surrounding radiative region. The resonant coupling causes a dip in the P – ΔP relation, distinct from the modulations due to the chemical composition gradient. Such a resonance dip in ΔP of prograde dipole g modes appears around a frequency corresponding to a spin parameter 2frot(cc)/νco-rot ∼8–11 with frot(cc) being the rotation frequency of the convective core and νco-rot the pulsation frequency in the co-rotating frame. The spin parameter at the resonance depends somewhat on the extent of core overshooting, central hydrogen abundance, and other stellar parameters. We can fit the period at the observed dip with the prediction from prograde dipole g modes of a main-sequence model, allowing the convective core to rotate differentially from the surrounding g-mode cavity. We have performed such fittings for 16 selected γ Dor stars having well-defined dips, and found that the majority of γ Dor stars we studied rotate nearly uniformly, while convective cores tend to rotate slightly faster than the g-mode cavity in less evolved stars.

The pulsational properties of ultra-massive DB white dwarfs with carbon-oxygen cores coming from single-star evolution

Context. Ultra-massive white dwarfs are relevant for many reasons: their role as type Ia supernova progenitors, the occurrence of physical processes in the asymptotic giant branch phase, the existence of high-field magnetic white dwarfs, and the occurrence of double white dwarf mergers. Some hydrogen-rich ultra-massive white dwarfs are pulsating stars and, as such, they offer the possibility of studying their interiors through asteroseismology. On the other hand, pulsating helium-rich ultra-massive white dwarfs could be even more attractive objects for asteroseismology if they were found, as they should be hotter and less crystallized than pulsating hydrogen-rich white dwarfs, something that would pave the way for probing their deep interiors. Aims. We explore the pulsational properties of ultra-massive helium-rich white dwarfs with carbon-oxygen and oxygen-neon cores resulting from single stellar evolution. Our goal is to provide a theoretical basis that could eventually help to discern the core composition of ultra-massive white dwarfs and the scenario of their formation through asteroseismology, anticipating the possible future detection of pulsations in helium-rich ultra-massive white dwarfs. Methods. We focus on three scenarios for the formation of helium-rich ultra-massive white dwarfs. First, we consider stellar models coming from two recently proposed single-star evolution scenarios for the formation of ultra-massive white dwarfs with carbon-oxygen cores that involve the rotation of the degenerate core after core helium burning and reduced mass-loss rates in massive asymptotic giant branch stars. Finally, we contemplate ultra-massive oxygen-neon core white-dwarf models resulting from standard single-star evolution. We compute the adiabatic pulsation gravity-mode periods for models in a range of effective temperatures, embracing the instability strip of average-mass pulsating helium-rich white dwarfs, and we compare the characteristics of the mode-trapping properties for models of different formation scenarios through the analysis of the period spacing. Results. Given that the white dwarf models coming from the three scenarios considered are characterized by distinct core chemical profiles, we find that their pulsation properties are also different, thus leading to distinctive signatures in the period-spacing and mode-trapping properties. Conclusions. Our results indicate that in the case of an eventual detection of pulsating ultra-massive helium-rich white dwarfs, it would be possible to derive valuable information encrypted in the core of these stars in connection with the origin of such exotic objects. This is of the utmost importance regarding recent evidence for the existence of a population of ultra-massive white dwarfs with carbon-oxygen cores. There will soon be many opportunities to detect pulsations in these stars through observations collected with ongoing space missions.

The formation of ultra-massive carbon-oxygen core white dwarfs and their evolutionary and pulsational properties

Context.The existence of ultra-massive white dwarf stars,MWD ≳ 1.05 M⊙, has been reported in several studies. These white dwarfs are relevant for the role they play in type Ia supernova explosions, the occurrence of physical processes in the asymptotic giant-branch phase, the existence of high-field magnetic white dwarfs, and the occurrence of double-white-dwarf mergers.Aims.We aim to explore the formation of ultra-massive, carbon-oxygen core white dwarfs resulting from single stellar evolution. We also intend to study their evolutionary and pulsational properties and compare them with those of the ultra-massive white dwarfs with oxygen-neon cores resulting from carbon burning in single progenitor stars, and with binary merger predictions. The aim is to provide a theoretical basis that can eventually help to discern the core composition of ultra-massive white dwarfs and the circumstances of their formation.Methods.We considered two single-star evolution scenarios for the formation of ultra-massive carbon-oxygen core white dwarfs, which involve the rotation of the degenerate core after core helium burning and reduced mass-loss rates in massive asymptotic giant-branch stars. We find that reducing standard mass-loss rates by a factor larger than 5−20 yields the formation of carbon-oxygen cores more massive than 1.05 M⊙as a result of the slow growth of carbon-oxygen core mass during the thermal pulses. We also performed a series of evolutionary tests of solar-metallicity models with initial masses between 4 and 9.5M⊙and with different core rotation rates. We find that ultra-massive carbon-oxygen core white dwarfs are formed even for the lowest rotation rates we analyzed, and that the range of initial masses leading to these white dwarfs widens as the rotation rate of the core increases, whereas the initial mass range for the formation of oxygen-neon core white dwarfs decreases significantly. Finally, we compared our findings with the predictions from ultra-massive white dwarfs resulting from the merger of two equal-mass carbon-oxygen core white dwarfs, by assuming complete mixing between them and a carbon-oxygen core for the merged remnant.Results.These two single-evolution scenarios produce ultra-massive white dwarfs with different carbon-oxygen profiles and different helium contents, thus leading to distinctive signatures in the period spectrum and mode-trapping properties of pulsating hydrogen-rich white dwarfs. The resulting ultra-massive carbon-oxygen core white dwarfs evolve markedly slower than their oxygen-neon counterparts.Conclusions.Our study strongly suggests the formation of ultra-massive white dwarfs with carbon-oxygen cores from a single stellar evolution. We find that both the evolutionary and pulsation properties of these white dwarfs are markedly different from those of their oxygen-neon core counterparts and from those white dwarfs with carbon-oxygen cores that might result from double-degenerate mergers. This can eventually be used to discern the core composition of ultra-massive white dwarfs and their formation scenario.

The Effect of Eight Weeks of Sling-Based Training with Rotational Core Exercises on Ball Velocity in Female Team Handball Players.

The purpose of this study was to investigate whether sling-based training focused on rotational exercises would improve shooting performance in outfield handball players during the competitive season, and whether changes in performance were related to altered levels of core strength and rotational velocity. Twenty-five female outfield handball players (mean age 19.5 ± 2.0 years, height 1.72 ± 0.06 m, body mass 71.5 ± 8.6 kg, training experience 10.3 ± 2.4 years), performed 7 m shots, with and without a run-up, and jump shots. Maximal ball velocity, peak rotational velocity of the trunk with different loads and 1RM in a core strength test were measured before and after an 8-week training intervention. Players were divided into a sling-based and a plyometric/sprint training (control) group that trained three times per week for 8 weeks. The main findings were that sling-based training increased ball velocity by on average 3.2% across three techniques tested, while shooting performance decreased by 3% in the control group. However, both training groups demonstrated increased peak rotational velocity with different loads, but not the calculated 1RM core strength after the training period. It was concluded that sling-based training with rotational core exercises could improve maximal ball velocity in female handball players during a competitive season by around 3%. However, this increased ball velocity may have been caused by increased angular velocity in the core, rather than absolute maximal core strength. It is suggested that sling-based training has impacted timing variables of the different involved segments, or possibly power transfer between segments, which may explain the enhancement in ball velocity.

Modeling of magneto-rotational stellar evolution

While magnetic fields have long been considered significant for the evolution of magnetic non-degenerate stars and compact stars, it has become clear in recent years that, in fact, all stars are deeply affected by their effects. This is particularly true regarding their internal angular momentum distribution, but magnetic fields may also influence internal mixing processes and even the fate of the star. We propose a new framework for stellar evolution simulations in which the interplay between magnetic field, rotation, mass loss, and changes in the stellar density and temperature distributions are treated self-consistently. For average large-scale stellar magnetic fields that are symmetric to the axis of the rotation of the star, we derive 1D evolution equations for the toroidal and poloidal components from the mean-field magnetohydrodynamic equation by applying Alfvén’s theorem; and, hence, a conservative form of the angular momentum transfer due to the Lorentz force is formulated. We implement our formalism into a numerical stellar evolution code and simulate the magneto-rotational evolution of 1.5M⊙stars. The Lorentz force aided by the Ω effect imposes torsional Alfvén waves propagating through the magnetized medium, leading to near-rigid rotation within the Alfvén timescale. Our models, with different initial spins andB-fields, can reproduce the main observed properties of Ap/Bp stars. Calculations that are extended to the red-giant regime show a pronounced core-envelope coupling, which are capable of reproducing the core and surface rotation periods already determined by asteroseismic observations.

A Survey Comparing Adult and Child Psychiatry Trainees, Faculty, and Program Directors' Perspectives About Telepsychiatry: Implications for Clinical Care and Training.

Telepsychiatry’s effectiveness is well established, and interest in it is growing, despite few residency/fellowship core curricula and rotations. A link to a cross-sectional survey was sent via national organization listservs for psychiatry residents, fellows, faculty, and program directors to complete. The survey queried demographics, clinical experience, and views/concerns about telepsychiatry. Descriptive statistics and other analyses compared groups to assess the impact of amount clinical experience and psychiatric specialty (general vs. child and adolescent psychiatry), on interest, and views/concerns about the practice of telepsychiatry. All respondents (N = 270; child psychiatry N = 89) have limited clinical experience with telepsychiatry (46% overall; 49% of non-child had none versus 40% child). Trainees (N = 123; child N = 43) expressed less interest than others. All respondents expressed worry about ability to do a physical exam, connectivity, medico-legal issues, and fit for diverse populations. Child respondents expressed less concern than others, but they reported more worry about loss of nonverbal cues. Clinical experience with telepsychiatry in the range of 6–20 h appears to build interest and allay concerns, though 1–5 h also may have a positive impact. More research is needed to assess clinical experience, interest, and concerns for adult and child psychiatry trainees and clinicians. Replicable, curricular interventions appear to be indicated.

Experimental Confirmation of a Topological Isomer of the Ubiquitous Au25(SR)18 Cluster in the Gas Phase

High-resolution electrospray ionization ion mobility mass spectrometry has revealed a gas-phase isomer of the ubiquitous, extremely well-studied Au25(SR)18 cluster both in anionic and cationic form. The relative abundance of the isomeric structures can be controlled by in-source activation. The measured collision cross section of the new isomer agrees extremely well with a recent theoretical prediction (MatusM. F.; et al. Chem. Commun.2020, 56, 8087) corresponding to a Au25(SR)18– isomer that is energetically close and topologically connected to the known ground-state structure via a simple rotation of the gold core without breaking any Au–S bonds. The results imply that the structural dynamics leading to isomerization of thiolate-protected gold clusters may play an important role in their gas-phase reactions and that isomerization could be controlled by external stimuli.

Inferring physical properties of stellar collapse by third-generation gravitational-wave detectors

Galactic core-collapse supernovae are among the possible sources of gravitational waves. We investigate the ability of gravitational-wave observatories to extract the properties of the collapsing progenitor from the gravitational waves radiated. We use simulations of supernovae that explore a variety of progenitor core rotation rates and nuclear equations of state and examine the ability of current and future observatories to determine these properties using gravitational-wave parameter estimation. We use principal component analysis of the simulation catalog to determine the dominant features of the waveforms and create a map between the measured properties of the waveform and the physical properties of the progenitor. We use Bayesian parameter inference and the parameter map to calculate posterior probabilities for the physical properties given a gravitational-wave observation. We estimate the ratio of the progenitor's core rotational kinetic energy to potential energy ($\beta$) and the post bounce oscillation frequency. For a supernovae at the distance of the galactic center (8.1 kpc) with $\beta = 0.02$ our method can estimate $\beta$ with a $90\%$ credible interval of $0.004$ for Advanced LIGO, improving to $0.0008$ for Cosmic Explorer. We demonstrate that if the core is rotating sufficiently rapidly for a signal observed by Cosmic Explorer, our method can also extract the post bounce oscillation frequency of the protoneutron star to a precision of within $5$~Hz ($90\%$ credible interval) allowing us to constrain the nuclear equation of state. For a supernovae at the distance of the Magellanic Clouds (48.5 kpc) Cosmic Explorer's ability to measure these parameters decreases slightly to $0.003$ for rotation and $11$~Hz for the postbounce oscillation frequency ($90\%$ credible interval). Sources in Magellanic Clouds will be too distant for Advanced LIGO to measure these properties.

Postoperative pain management education during the surgery core rotation at McMaster University, Waterloo Regional Campus.

Background: Opioid over-prescription continues to be a challenge in the postoperative setting for management of acute pain. Initiatives have been developed to standardize postoperative opioid prescribing with an emphasis on multimodal pain management. However, there is a concern medical education has not remained current on this topic.&#x0D; Objective: The aim of this study is to explore current teaching around postoperative pain management during the surgery core rotation at McMaster University, Waterloo Regional Campus (WRC), and identify any opportunities for improvement.&#x0D; Methods: A 13-item survey was developed to determine effectiveness of teaching around postoperative pain management during the surgery core and its alignment with current guidelines. The survey was disseminated to third year medical students at the WRC.&#x0D; Results: Seven of nine respondents indicated that teaching on postoperative pain management and opioid reduction strategies was provided during the surgery core. All respondents receiving this teaching also indicated learning about a multimodal pain control approach consistent with current guidelines. However, only three of seven respondents noted receiving teaching on providing patient and caregiver education around the pain management plan, despite a strong recommendation in guidelines in favour of this practice.&#x0D; Conclusions: Most students receive teaching on multimodal postoperative pain management and opioid reduction strategies during the surgery core at the WRC. Opportunities to strengthen the teaching include addressing the role of patient and caregiver education in the pain management plan as well as incorporating the topic into formal teaching such as classroom sessions or learning objectives in the surgery core. &#x0D; Keywords: postoperative; opioids; multimodal pain management; medical education; surgery

Grassy ELM regime at low pedestal collisionality in high-power tokamak plasma

Spontaneous mitigation of giant ELMs and appearance of grassy ELMs have been observed repeatedly at low pedestal collisionality () in the high-power (P inj > 13 MW) hybrid scenario in DIII-D. Higher β p and higher q 95 appear to be beneficial to achieving the grassy ELM regime. The grassy ELM H-mode plasma shows high energy confinement performance (H 98y2 up to over 1.5) under the conditions of high neutral beam torque and high core rotation. The pedestal width appears to exceed the EPED1.0 model prediction by more than 50%. Pedestal stability analysis performed with the ELITE code indicates that the stability against low-n kink/peeling modes is improved with increased auxiliary heating power and the operational point in the grassy ELM regime is located near the ballooning boundary. The pedestal stability characteristics during the grassy ELM crashes have been investigated in comparison with the giant ELM crashes based on plasma profiles experimentally measured with high resolution and accuracy. It has been found that the underlying mechanism for the observed small-amplitude ELM crashes is mainly the expansion of the ballooning stability boundary induced by an initial radially localized collapse in the pedestal, which helps to stop the growth of instabilities and further collapse of the pedestal. The effect of electron density pedestal on mitigating edge localized instabilities has been analyzed by numerical simulation, suggesting that the electron density pedestal characterized by high n e,sep/n e,ped and low density gradient helps to stabilize peeling-ballooning modes because of a low pressure pedestal gradient and to lower the ballooning boundary mainly because of a low ion diamagnetic frequency in the pedestal region, thus triggering ballooning instabilities and producing the intrinsic grassy ELMs. Numerical simulation of the Chinese fusion engineering test reactor (CFETR) with the SOLPS code indicates that the separatrix density might be insensitive to the electron diffusivity in the pedestal region and increase with the power flowing from the core region to the edge region. Pedestal stability analysis suggests that the flat density pedestal with high separatrix density obtained in the high-power plasma in CFETR would make the operational point close to the ballooning boundary, which is considered to help destabilize ballooning instabilities and facilitate the access to the grassy ELM regime.

Interrater Agreement and Reliability of Burn Size Estimations Between Emergency Physicians and Burn Unit.

The initial approach to burn injuries has remained relatively unchanged over the past several decades and revolves around trauma assessment and fluid resuscitation, frequently initiated in the emergency department (ED). While previous research suggests that emergency physicians (EP) are poor estimators at total body surface area (TBSA) affected, we believe that estimation differences are improving, specifically at academic centers with co-located burn units that emphasize burn injury education. This study investigated the interrater agreement and reliability of burn size estimations at an academic ED and its co-located burn unit. This single-center, retrospective study was conducted at a large academic ED with a co-located burn unit. The study included adult patients admitted to the burn unit after receiving paired burn size estimations from EPs and the burn unit. The primary endpoint was the interrater agreement, measured by the kappa coefficient, κ, of 10% TBSA estimation intervals. The secondary endpoint was the intraclass correlation coefficient (ICC), evaluating the reliability of exact, nonranged, and TBSA estimations. A chart review was performed for patients evaluated from November 1, 2016 to July 31, 2019. One thousand one hundred and eighty-four patients were admitted to the burn unit, 1176 of which met inclusion criteria for the primary endpoint. The κ of TBSA between EPs and the burn unit was 0.586, while the weighted κ was 0.775. These values correlate with moderate and substantial agreements, respectively. Additionally, 971 patients had exact TBSA estimations from paired EPs and the burn unit which were used for the secondary endpoint. The ICC between EPs and the burn unit was 0.966, demonstrating an excellent reliability. Further sub-analysis was performed, revealing mean over- and underestimation differences of exact TBSA estimations of 3.93 and 2.93, respectively. EPs at academic institutions with co-located burn units are accurate estimators of TBSA in the assessment of burn injuries. We believe that burn education, to include core rotations within the burn unit, plays a major role in improved burn size estimations.

Inverse tides in pulsating binary stars

ABSTRACT In close binary stars, the tidal excitation of pulsations typically dissipates energy, causing the system to evolve towards a circular orbit with aligned and synchronized stellar spins. However, for stars with self-excited pulsations, we demonstrate that tidal interaction with unstable pulsation modes can transfer energy in the opposite direction, forcing the spins of the stars away from synchronicity, and potentially pumping the eccentricity and spin–orbit misalignment angle. This ‘inverse’ tidal process only occurs when the tidally forced mode amplitude is comparable to the mode’s saturation amplitude, and it is thus most likely to occur in main-sequence gravity mode pulsators with orbital periods of a few days. We examine the long-term evolution of inverse tidal action, finding the stellar rotation rate can potentially be driven to a very large or very small value, while maintaining a large spin–orbit misalignment angle. Several recent asteroseismic analyses of pulsating stars in close binaries have revealed extremely slow core rotation periods, which we attribute to the action of inverse tides.

Impact of a health‐system longitudinal advanced pharmacy practice experience on student growth and postgraduate career placement

AbstractWhile most longitudinal advanced pharmacy practice experiences (LAPPEs) include sequential core rotations, programs vary regarding additional elements offered. Pharmacy residency programs have become increasingly competitive with applicants outnumbering available positions. LAPPEs can help students improve their candidacy for postgraduate training while also benefiting health systems.ObjectiveTo describe the health‐system perspective of a LAPPE designed to build professional skills in students to best prepare them for subsequent career pursuits.MethodsStudents enrolled in the Eskenazi Health (EH) LAPPE were asked to complete pre‐ and postprogram assessments regarding career interests, strengths, areas for improvement, and goals. Students were also asked to rank their comfort level with 27 clinical skills in four categories. Additionally, a survey was distributed to all program alumni to gather demographic and qualitative data.ResultsIn the 9 years since inception, 52 students have enrolled in the EH LAPPE. Of the 44 program graduates surveyed, 41 responded (93%). Of these, 95% completed postgraduate training in 18 different states and two obtained jobs directly following graduation. The majority (54%) applied for a postgraduate year one (PGY1) residency at our institution, of which 11 (27%) matched for at least 1 year of residency training. A total of 32 students completed the pre‐ and postprogram skills assessments which demonstrated a statistically significant increase in comfort level in all 27 skills, with a median increase of 1.5 on a 4‐point scale. Clinical research, mentors, and mock interviews were identified as most helpful to program alumni.ConclusionsThe EH LAPPE can serve as an example for health‐systems wishing to institute a similar program. Students experienced perceived growth and increased confidence in various patient care activities, and successful career placement suggests that students benefited from career preparation elements of the LAPPE. LAPPEs can provide benefits to health systems through student contributions and should be considered by sites looking for growth and unique precepting opportunities.

The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate medical training: results from multiple samplings of a single cohort

BackgroundMedicine is a field that is simultaneously factual and ambiguous. Medical students have their first exposure to full time clinical practice during clerkship. While studies have examined medical trainees’ tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. The aim of this study was to evaluate the effect of clerkship experience on TOA and perfectionism in medical students.MethodsThis was a multiple sampling, single cohort study of students in their first year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their first (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via t-tests.ResultsFrom a cohort of 174 clinical clerkship students, 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a significant decrease in TOA (p < 0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not significantly different over time (p > 0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r = 0.32) that increased slightly after clerkship (r = 0.39). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in pre-clerkship than those choosing other specialties, but this difference was not found post-clerkship.ConclusionExposure to clerkship decreased TOA while perfectionism remained stable in medical students. These results were not expected as exposure has been previously shown to increase TOA. The frequency of rotation changes maintaining a cycle of anxiety may be an underlying factor accounting for these results. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.

Using mobile technology in assessment of entrustable professional activities in undergraduate medical education.

BackgroundThe adoption of competency-based medical education requires objective assessments of a learner’s capability to carry out clinical tasks within workplace-based learning settings. This study involved an evaluation of the use of mobile technology to record entrustable professional activity assessments in an undergraduate clerkship curriculum.ApproachA paper-based form was adapted to a mobile platform called eClinic Card. Students documented workplace-based assessments throughout core clerkship and preceptors confirmed accuracy via mobile phones. Assessment scores for the 2017–2018 academic year were collated and analyzed for all core rotations, and preceptors and students were surveyed regarding the mobile assessment experience.EvaluationThe mobile system enabled 80 students and 624 preceptors to document 6850 assessment submissions across 47 clinical sites over a 48-week core clerkship curriculum. Students’ scores demonstrated progressive improvement across all entrustable professional activities with stage-appropriate levels of independence reported by end of core clerkship. Preceptors and students were satisfied with ease of use and dependability of the mobile assessment platform; however, students felt quality of formative coaching feedback could be improved.ReflectionOur preliminary evaluation suggests the use of mobile technology to assess entrustable professional activity achievement across a core clerkship curriculum is a feasible and acceptable modality for workplace-based assessment. The use of mobile technology supported a programmatic assessment approach. However, meaningful coaching feedback, as well as faculty development and support, emerged as key factors influencing successful adoption and usage of entrustable professional activities within an undergraduate medical curriculum.Electronic supplementary materialThe online version of this article (10.1007/s40037-020-00618-9) contains supplementary material, which is available to authorized users.

Design and simulation of rotated hexagonal porous core photonic crystal fibre with improved effective material loss and dispersion properties

&lt;p&gt;&lt;span&gt;A thorough modal characterization, centred on the full vectorial finite element method (FEM) has been used to model and numerically investigate a porous core photonic crystal fibre (PC-PCF), which may potentially be integrated into Terahertz (10&lt;sup&gt;12&lt;/sup&gt; Hz) compact systems. The proposed fibre consists of a rotated hexagonal core surrounded by a conventional hexagonal cladding. It has been shown that effective material loss (EML), core power fraction and dispersion profile are 0.019 cm&lt;sup&gt;-1&lt;/sup&gt;, 51.7% and 0.5 ± 0.04 ps/THz/cm within 1 THz bandwidth, respectively. Based on simulated results and noncomplex design, it is envisaged that the proposed fibre can be realised for industrial THz applications. &lt;/span&gt;&lt;/p&gt;

233TF Making Antibiotics Stick

Learning in medical school still involves the “fire hose model” where vast amounts of information are being unleashed upon the students who are then responsible for recalling as much as possible in order to pass the test. The challenge occurs when they make the transition from fourth year medical student to first year resident, when they need to recall the information learned, more precisely, when they need to know what information to recall. In order to facilitate this transition, I created an online module to help the students recall useful antibiotics once they start their internship and are faced with the responsibility of being a doctor. In creating this module, I am combining two well-known teaching principles, that of microteaching alongside spaced repetition. In order to take these concepts a step forward, I am combining the spaced repetition model with information retrieval as I am using the same quiz at different time intervals in order to facilitate long-term knowledge retention. This course is not intended to teach new information, but rather to allow the learner to review information once known and facilitate long-term recall. Study objective: At the end of this elective, the student/intern will be able to recall specific antibiotics to treat different infections, from common ones to deadly ones. Along with the name of the antibiotic, the student will recall the dose, the route and the frequency. During their emergency medicine core rotation, the learner will be enrolled in an online module composed of three sessions: two knowledge review sessions and a quiz. They will start by completing the quiz first, followed by completion of the two educational sessions during the assigned two weeks. Within one day of completing lesson two, the learner will be required to take the same quiz again. Once the student finishes the EM rotation, they will be enrolled in spaced repetition schedule where they will be receiving emails with links to take the same quiz at progressively longer time intervals. In this way, we can use spaced information retrieval to solidify the knowledge. The two knowledge review sessions were created using Articulate 360 platform and the spaced quizzes were created using “Google forms,” a free online resource. The spaced quizzes would serve both as teaching tools as well as assessment tools. The learner will also be asked to complete a 4-question survey of the course in order to fine tune the material as well as identify other potential topics suited for this format. Teaching antibiotics is just one of the thousands of topics that can be adapted to this teaching format. I can easily see this format being used to teach rare EKG finding such as Brugada, DeWInter’s, etc. This format could also be used to teach management of common ED presentations such as CHF exacerbation, PNA, sepsis etc. I can see creating an online database of such short, teaching modules that the learner can access at any time, modules focused on knowledge needed during “transition to the wards.”