Search

Introduction: COVID-19 forced health systems to rapidly implement telehealth for routine practice, often without sufficient training or standards. We conducted a longitudinal survey of physicians to explore changes in their perceptions of the challenges and benefits of telehealth and identify recommendations for future practice. Methods: An anonymous online survey was distributed to a cohort of internal medicine physicians in May to June 2020 and March to June 2021. Changes in responses between 2020 and 2021 and by site (private vs. public) were described. These findings, along with those of a thematic analysis of open-ended responses to questions on telehealth experiences, informed a set of recommendations. Results: The survey response rate was 111/391 in 2021 compared to 122/378 in 2020. Fewer physicians reported that telehealth was more difficult than in person with regards to taking a history (49% in 2020, 33% in 2021, p = 0.015), maximizing patient adherence (33% in 2020, 19% in 2021, p = 0.028), and maintaining patient relationships (31%, 25%, p = 0.009) in 2021. Similar proportions of physicians reported continued challenges with building new patient relationships (75%, 77%, p = 0.075), educating patients (40%, 32%, p = 0.393), and working collaboratively with their team (38%, 41%, p = 0.794). Physicians reported increased satisfaction with tele-visits over in-person visits (13%, 27%, p = 0.006) and less worry over doing future tele-visits (45%, 31%, p = 0.027). Physicians' open-ended responses identified recommendations for further improving the design and use of telehealth. Discussion: Results suggest that physician experience with telehealth improved but opportunities for training and improved integration remain. Longitudinal assessment can deepen understanding of the evolution of telehealth care. [ABSTRACT FROM AUTHOR]

Dust storms and the atmospheric waves can play a significant role in the dynamics in the upper neutral atmosphere of Mars. Recent observations found that a periodic variation of neutral H and O exists in the upper atmosphere, which is likely associated with atmospheric waves that occurred during the regional dust storm on 4 September 2016. However, such periodic variations accompanying the dust storm are far from understood in terms of the Martian ionized particles (i.e., ionosphere). Here we investigated the periodic variation of the ion density in the Martian ionosphere during the regional dust storm in September 2016 based on the MAVEN/STATIC observations. Assuming a simple Chapman layer model, we implemented numerical fitting for the ion density altitude profile to retrieve the peak ion densities in the Martian ionosphere. We then applied periodogram analysis to these peak ion densities in order to identify the peak periodicities together with their confidence levels. We identified several distinct peak periodicities with a scale from ~1 day up to ~20 days. The peak periodicities around 6-9 days are comparable to those seen in the Martian neutral atmosphere. In addition, the other peak periodicities likely correspond to the periodic crossings of the local crustal fields and periodic variation of the upstream solar wind, indicating a strong regional coupling between the lower atmosphere and the upstream solar wind. [ABSTRACT FROM AUTHOR]

Heavy cold ions at Mars are gravitationally bound to the planet unless some process provides energy to them. Observations show that cold (<20 eV) and dense (∼>1 cm−3) O+/O2+ ions with bulk velocities equal to energies ∼1 keV can reach deep into the nightside Martian magnetosheath. These ions are co‐located with a change of the sign of the sunward component of the magnetic field. This magnetic field topology implies the persistence of a localized planetary ions escape channel associated with draped magnetic field lines that are convecting tailward. The observed ion populations propagate approximately in the same direction as surrounding magnetosheath flow and are likely to be almost unheated ionospheric ions from low altitudes. The paper discusses planetary ion energization via Hall electric field originated from ions and electron separation associated with magnetic field curvature. Plain Language Summary: In‐situ observations above the nightside of Mars show the presence of localized dense planetary ion fluxes at altitudes exceeding 2,000 km and escaping from the planet at high energies, comparable to that of the solar wind. These fluxes are accompanied by the reversal of sunward component of magnetic field. Unlike most atmospheric escape channels, the reported phenomenon is characterized by an increase in heavy to light ions density ratio with the distance from the planet at the observed altitudes up to nearly 5,000 km, as well as an increase in overall plasma number density inside this escape channel relative to the ambient sheath environment. This behavior is consistent with acceleration process initiated by a bent magnetic flux tube. Key Points: Ions of different species gain similar energies in the Martian magnetosheath by Hall electric fields associated with magnetic curvatureA high concentration of ionospheric ions correlates with a near void of shocked solar wind protons and a magnetic field reversalNumber density at the reversal increases with distance from Mars in comparison to the surrounding sheath at least till two Martian radii [ABSTRACT FROM AUTHOR]

On 26–27 December 2022, Mars experienced an extremely low‐density solar wind stream, which was encountered first by Earth because of the radial alignment of the two planets (i.e., Mars opposition). During this event, two important properties of the ionospheric and magnetospheric states changed significantly in response to the low solar wind ram pressure, as inferred from the superthermal electron observations from the Mars Atmospheric and Volatile EvolutioN (MAVEN) mission. The interface between the ionosphere and magnetosphere expanded to thousands of kilometers, outside of the nominal bow shock locations, coinciding with the expansion of the cold planetary ions. Meanwhile, the ambipolar electrostatic potential arising from the ionospheric electron pressure gradient increased from the nominal ∼ −0.7 to ∼ −2 V (relative to the lower ionosphere). This enhanced ambipolar potential likely facilitated the observed ionosphere expansion. Key Points: This study characterizes Mars's magnetospheric and ionospheric response to the disappearing solar wind event in December 2022During the event, open and closed field lines extend beyond the nominal bow shock location, just as the planetary cold ionsThe ionospheric ambipolar potential drop is enhanced from the nominal ∼ −0.7 to ∼ −2 V, likely facilitating the ionosphere expansion [ABSTRACT FROM AUTHOR]

Background Although efforts are underway to address social determinants of health (SDOH), little is known about physicians' SDOH practices despite evidence that failing to fully elicit and respond to social needs can compromise patient safety and undermine both the quality and effectiveness of treatment. In particular, interventions designed to enhance response to social needs have not been assessed using actual practice behaviour. In this study, we evaluate the degree to which providing primary care physicians with feedback on their SDOH practice behaviours is associated with increased rates of eliciting and responding to housing and social isolation needs. Methods Unannounced standardised patients (USPs), actors trained to consistently portray clinical scenarios, were sent, incognito, to all five primary care teams in an urban, safety-net healthcare system. Scenarios involved common primary care conditions and each included an underlying housing (eg, mould in the apartment, crowding) and social isolation issue and USPs assessed whether the physician fully elicited these needs and if so, whether or not they addressed them. The intervention consisted of providing physicians with audit/feedback reports of their SDOH practices, along with brief written educational material. A prepost comparison group design was used to evaluate the intervention; four teams received the intervention and one team served as a 'proxy' comparison (no intervention). Preintervention (February 2017 to December 2017) rates of screening for and response to the scripted housing and social needs were compared with intervention period (January 2018 to March 2019) rates for both intervention and comparison teams. Results 108 visits were completed preintervention and 183 during the intervention period. Overall, social needs were not elicited half of the time and fully addressed even less frequently. Rates of identifying the housing responding to housing needs increased significantly for intervention teams (15%-41%; p=0.004) but not for the comparison team (21%-29%; p=0.663). Social isolation was identified more frequently postintervention (53%) compared with baseline (39%; p=0.041) among the intervention teams but remained unchanged for the comparison team (39% vs 32%; p=0.601). Full exploration of social isolation remained low for both intervention and comparison teams. Conclusions Results suggest that physicians may not be consistently screening for or responding to social needs but that receiving feedback on those practices, along with brief targeted education, can improve rates of SDOH screening and response. [ABSTRACT FROM AUTHOR]

To describe patterns of clinical communication skills that inform curriculum enhancement and guide coaching of medical students. Performance data from 1182 consenting third year medical students in 9 cohorts (2011–2019), on a 17-item Clinical Communication Skills Assessment Tool (CCSAT) completed by trained Standardized Patients as part of an eight case high stakes Comprehensive Clinical Skills Exam (CCSE) were analyzed using latent profile analysis (LPA). Assessment domains included: information gathering (6 items), relationship development (5 items), patient education (3 items), and organization/time management (3 items). LPA clustered learners with similar strength/weakness into profiles based on item response patterns across cases. One-way analysis of variance (ANOVA) assessed for significant differences by profile for CCSAT items. Student performance clustered into six profiles in three groups, high performing (HP1 and HP2-Low Patient Education, 15.7%), average performing (AP1 and AP2-Interrupters, 40.9%), and lower performing profiles (LP1-Non-interrupters and LP2, 43.4%) with adequate model fit estimations and similar distribution in each cohort. We identified 3 CCSAT items that discriminated among learner's skill profiles. Clinical communication skill performance profiles provide nuanced, benchmarked guidance for curriculum improvement and tailoring of communication skills coaching. [ABSTRACT FROM AUTHOR]

Objective: To evaluate a nutrition curriculum and explore the influence of medical students' own nutrition practices on its impact. Methods: An anonymous survey was given to first-year medical students attending a required course immediately prior to and 2 weeks after a 2-hour interactive nutrition curriculum intervention in a large private urban medical school in New York, New York. Main outcomes included self-reported nutrition counseling confidence, ability to assess diet, and nutrition knowledge measured using 4-point Likert scales. Results: One hundred eleven students completed surveys pre-curriculum (69%) and 121 completed them post-curriculum (75%). The authors found overall pre-post differences in dietary assessment ability (2.65 vs 3.05, "P" less than 0.001) and counseling confidence (1.86 vs 2.22, "P" less than 0.001). In addition to the curricular impact, students' nutrition-related behaviors and attitudes were positively associated with outcomes. Conclusions and Implications: A nutrition curriculum for medical students improves students' nutrition counseling-related confidence, knowledge, and skills even when controlling for personal nutrition-related behaviors. (Contains 3 tables.)