A set of long-term tests (t≥1000h) have been carried out in fuel cell and electrolysis modes on typical Ni-YSZ//YSZ//LSCF-CGO cells. The degradation rates were found to be higher in electrolysis than ...in fuel cell operation. Post-test analyses have revealed that Sr diffusion and formation of SrZrO3 at YSZ/CGO interface occur mainly during electrolysis operation, whereas the process is very limited in fuel cell mode. As a consequence, LSCF destabilization is found to be not involved in the degradation of cell performances during fuel cell operation while it could explain the highest degradation rates recorded in electrolysis mode. An in-house multi-scale model has been used to interpret the role of the cell operating mode on the LSCF demixing mechanism. The simulations have shown that the electrolysis operation leads to a strong depletion of oxygen vacancies in LSCF material (while the fuel cell condition results in an increase in the concentration of oxygen vacancies). It has been proposed that the depletion in oxygen vacancies under electrolysis polarization could drive the Sr release from the structure, and in turn, could explain the experimental results. Based on this proposition, a possible mechanism for the LSCF destabilization and SrZrO3 formation is detailed.
A high voltage LiNi0.5Mn0.3Co0.2O2/graphite cell with a fluorinated electrolyte formulation 1.0 m LiPF6 fluoroethylene carbonate/bis(2,2,2‐trifluoroethyl) carbonate is reported and its ...electrochemical performance is evaluated at cell voltage of 4.6 V. Comparing with its nonfluorinated electrolyte counterpart, the reported fluorinated one shows much improved Coulombic efficiency and capacity retention when a higher cut‐off voltage (4.6 V) is applied. Scanning electron microscopy/energy dispersive X‐ray spectroscopy and X‐ray photoelectron spectroscopy data clearly demonstrate the superior oxidative stability of the new electrolyte. The structural stability of the bulk cathode materials cycled with different electrolytes is extensively studied by X‐ray absorption near edge structure and X‐ray diffraction.
A high voltage electrolyte based on fluoroethylene carbonate and bis(2,2,2‐trifluoroethyl) carbonate is developed for high voltage LiNi0.5Mn0.3Co0.2O2/graphite cells cycled between 3.0–4.6 V. The enhanced oxidative stability of the fluorinated electrolyte is examined by electrochemical cycling, microscopy, and electroscopy. The reported electrolyte also passivates the graphite enabling reversible Li+ intercalation/deintercalation on the anode side.
An important development in higher education is the increased learning possibilities brought by ICT. Many academics seem reluctant to embrace technology. An online teacher training program was ...followed by 73 academics from nine higher educational institutions. Data were gathered using the Technological Pedagogical Content Knowledge (TPACK) model and the Teacher Beliefs and Intentions questionnaire using a pre–post test-design. The results amongst 33 participants who completed both pre- and post-test indicate that TPACK skills increased substantially. Over time academics were less convinced about the merits of knowledge transmission. Disciplines and institutional cultures, time investment and beliefs towards employability influenced training retention.
► Many teachers struggle to successfully embrace technology in the classroom. ► A cross-institutional online professionalisation module was followed by 73 academics. ► Impact online professionalisation module (pre–post): increased usage of technology. ► Increase in technological pedagogical content knowledge & TPACK. ► Lower intentions towards knowledge transmission.
Objectives
Well‐designed studies on the impact of a family medicine rotation on medical students are rare, and very few studies include a qualitative component. This study aimed to determine the ...improvement of medical students’ knowledge, communication skills and attitude towards primary care and explore their perceptions after rotations, in comparison with a control group.
Methods
We used a mixed‐methods design, comprising a pre‐test–post‐test comparison between a sample of trained students who took family medicine rotations and a control group and a qualitative survey. The measurement of improvement included (i) multiple choice question testing, (ii) objective structured checklist examinations, (iii) self‐reporting and (iv) interviews and focus group discussions. Data were collected from August 2017 to June 2018.
Results
There were 696 students in the trained group and 617 controls. The two groups’ baseline scores in knowledge, communication skills and attitude were not significantly different. Knowledge covering five domains of family medicine (Pearson's r from 0.6 to 0.9) improved significantly, as did attitudes towards primary care in the trained group. There were no differences in communication and counselling skills between the two groups for four situations, but for two–health check‐ups and mental health care–skills were significantly improved (Pearson's r from 0.28 to 0.43). The qualitative survey showed highly positive feedback from trained students.
Conclusions
The family medicine rotation significantly improved students’ knowledge and attitude towards primary care and some communication skills. Further studies should investigate students’ interest in and career choice for this discipline.
Objectifs
Des études bien conçues sur l'impact d'une rotation de la médecine familiale sur les étudiants en médecine sont rares et très peu d'études comprennent une composante qualitative. Cette étude visait à mesurer l'amélioration des connaissances, des compétences en communication et de l'attitude des étudiants en médecine à l'égard des soins primaires, et à explorer leurs perceptions après les rotations, en comparaison avec un groupe témoin.
Méthodes
Nous avons utilisé un concept de méthodes mixtes, comprenant une comparaison pre‐test et post‐test entre un échantillon d'étudiants formés qui ont effectué des rotations de la médecine familiale et un groupe témoins, et une enquête qualitative. La mesure de l'amélioration comprenait (1) des tests de questions à choix multiples, (2) des examens objectifs structurés de listes, (3) des rapports personnels et (4) des entretiens et des discussions focalisées de groupes. Les données ont été collectées d'août 2017 à juin 2018.
Résultats
Il y avait 696 élèves dans le groupe formé et 617 témoins. Les scores de référence des deux groupes en termes de connaissances, de communication et d'attitude n'étaient pas significativement différents. Les connaissances couvrant cinq domaines de la médecine familiale se sont considérablement améliorées (r de Pearson de 0,6 à 0,9), tout comme l'attitude à l’égard des soins primaires dans le groupe formé. Il n'y avait pas de différence dans les compétences de communication et de conseil entre les deux groupes pour quatre situations, mais pour deux (bilan de santé et soins de santé mentale) les compétences ont été significativement améliorées (r de Pearson de 0. 28 à 0. 43). L'enquête qualitative a montré une rétroaction très positive des étudiants formés.
Conclusions
La rotation de la médecine familiale a amélioré de manière significative la connaissance et l’attitude des étudiants à l'égard des soins primaires et certaines compétences de communications. Des études ultérieures devraient examiner l'intérêt des étudiants et le choix de carrière pour cette discipline.
Abstract
Aims
To determine the ranges of pre-test probability (PTP) of coronary artery disease (CAD) in which stress electrocardiogram (ECG), stress echocardiography, coronary computed tomography ...angiography (CCTA), single-photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance (CMR) can reclassify patients into a post-test probability that defines (>85%) or excludes (<15%) anatomically (defined by visual evaluation of invasive coronary angiography ICA) and functionally (defined by a fractional flow reserve FFR ≤0.8) significant CAD.
Methods and results
A broad search in electronic databases until August 2017 was performed. Studies on the aforementioned techniques in >100 patients with stable CAD that utilized either ICA or ICA with FFR measurement as reference, were included. Study-level data was pooled using a hierarchical bivariate random-effects model and likelihood ratios were obtained for each technique. The PTP ranges for each technique to rule-in or rule-out significant CAD were defined. A total of 28 664 patients from 132 studies that used ICA as reference and 4131 from 23 studies using FFR, were analysed. Stress ECG can rule-in and rule-out anatomically significant CAD only when PTP is ≥80% (76–83) and ≤19% (15–25), respectively. Coronary computed tomography angiography is able to rule-in anatomic CAD at a PTP ≥58% (45–70) and rule-out at a PTP ≤80% (65–94). The corresponding PTP values for functionally significant CAD were ≥75% (67–83) and ≤57% (40–72) for CCTA, and ≥71% (59–81) and ≤27 (24–31) for ICA, demonstrating poorer performance of anatomic imaging against FFR. In contrast, functional imaging techniques (PET, stress CMR, and SPECT) are able to rule-in functionally significant CAD when PTP is ≥46–59% and rule-out when PTP is ≤34–57%.
Conclusion
The various diagnostic modalities have different optimal performance ranges for the detection of anatomically and functionally significant CAD. Stress ECG appears to have very limited diagnostic power. The selection of a diagnostic technique for any given patient to rule-in or rule-out CAD should be based on the optimal PTP range for each test and on the assumed reference standard.
Genetic and genomic technologies can effectively diagnose numerous genetic disorders. Patients benefit when genetic counselling accompanies genetic testing and international guidelines recommend pre‐ ...and post‐test genetic counselling with genome‐wide sequencing. However, there is a gap in knowledge regarding the unique genetic counselling considerations with different types of genetic testing in the Neonatal Intensive Care Unit (NICU) and the Pediatric Intensive Care Unit (PICU). This scoping review was conducted to identify the gaps in care with respect to genetic counselling for infants/pediatric patients undergoing genetic and genomic testing in NICUs and PICUs and understand areas in need of improvement in order to optimize clinical care for patients, caregivers, and healthcare providers. Five databases (MEDLINE Ovid, Embase Ovid, PsycINFO Ebsco, CENTRAL Ovid, and CINHAL Ebsco) and grey literature were searched. A total of 170 studies were included and used for data extraction and analysis. This scoping review includes descriptive analysis, followed by a narrative account of the extracted data. Results were divided into three groups: pre‐test, post‐test, and comprehensive (both pre‐ and post‐test) genetic counselling considerations based on indication for testing. More studies were conducted in the NICU than the PICU. Comprehensive genetic counselling was discussed in only 31% of all the included studies demonstrating the need for both pre‐test and post‐test genetic counselling for different clinical indications in addition to the need to account for different cultural aspects based on ethnicity and geographic factors.
Considerations for optimizing genetic counselling (both pre‐ and post‐test) in intensive care settings.
Background and Objectives
Notifying blood donors of their reactive status for transfusion‐transmitted infections (TTIs) plays a vital role in enabling early diagnosis and management while also ...preventing these donors from making future donation and transmission of the infectious agent. Given the limited data on donor notification processes in India, a narrative review was conducted to assess the existing notification process and identify areas requiring enhancement.
Materials and Methods
We conducted literature searches using PubMed, Google Scholar and Scopus, employing various keywords. The review included data on the year of the study, study design, donor numbers, TTI screening methods, sero‐reactive donor confirmation, notification frequency and methods, donor responses, post‐test counselling and risk factor assessment.
Results
Out of the 29 identified articles, 16 studies were included in the analysis. Repeat testing for initially reactive results was conducted in nine studies for 24.3% reactive donors. Phone calls were the primary notification method in most studies (8; 50%), with letters sent in cases of no response. Only 12 studies provided data on notified donors, revealing a notification rate of 71.2%. Of all initially reactive donors, 33.3% sought post‐test counselling. Data from six studies indicated that 74.3% of responsive donors had identifiable TTI risk factors.
Conclusion
Our review revealed significant variability in the notification processes across different studies. To enhance the management of TTI‐reactive donor notifications and responses, we recommend the establishment of universal protocols encompassing pre‐donation counselling, repeat/confirmatory testing, notification methods and comprehensive follow‐up and treatment.
•Direct internal reforming (DIR) experiments are performed with simulated biogas and steam addition.•Experiments at 850 °C with up to 12 ppm(v) HCl in biogas revealed no significant impact on DIR or ...cell deterioration.•At 800 °C, DIR is very marginally affected, whereas both DIR and cell performance are marginally affected at 750 °C.•The HCl level used is at par with the reported level in sewage biogas.•Post-test analyses of the SOFC reveals no microstructure changes, chlorine infiltration, or nickel chloride formation.
This study is particularly aimed at investigating the influence of hydrogen chloride traces in biogas on direct internal reforming in solid oxide fuel cells (SOFCs). The experiments are performed with simulated biogas containing methane to carbon dioxide ratio of 3:2, the usual average proportion in biogas. To the best of our knowledge, there are no reported studies that investigated the effect of hydrogen chloride on direct internal reforming by clearly establishing the effect of reforming with outlet gas composition measurements. The experiments at SOFC operating temperature of 850 °C reveals no negative effect on reforming or cell performance, with 4, 8, and 12 ppm(v) of hydrogen chloride in biogas. At 800 °C, there is no visible performance degradation, but a negligible amount of methane (∼ 1%) is detected in the anode off gas. Both the reforming and electrochemical performance are marginally affected at 750 °C. Further, post-test analyses (FESEM-EDS, XRD) of the used SOFC reveals no damage to the cell at microstructure level or chlorine poisoning. All the experiments are performed in the context of utilizing the biogas generated from sewage treatment plants in an SOFC system. The reported level of chlorine traces in biogas generated from sewage sludge is < 10 ppm(v) and hence the limit set for experiments is at par with this value.
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The sensitivity and specificity of a test cannot be used to estimate probability of disease in individual patients. They can, however, be combined into a single measure called the likelihood ratio ...which is, clinically, more useful than sensitivity or specificity. Likelihood ratios provide a summary of how many times more (or less) likely patients with a disease are to have a particular result than patients without the disease. Using the principles of the Bayes theorem, likelihood ratios can be used in conjunction with pre‐test probability of disease to estimate an individual's post‐test probability of disease, that is his or her chance of having disease once the result of a test is known. The Fagan's nomogram is a graphical tool which, in routine clinical practice, allows one to combine the likelihood ratio of a test with a patient's pre‐test probability of disease to estimate post‐test probability.
Conclusion: Likelihood ratios summarize information about a diagnostic test by combining sensitivity and specificity. The Fagan's nomogram is a useful and convenient graphical tool that allows likelihood ratios to be used in conjunction with a patient's pre‐test probability of disease to estimate the post‐test probability of disease.
Healthcare professionals have a role to play in reducing perinatal mental health related stigma.
To assess the effectiveness of a video-based educational intervention developed to provide guidance to ...healthcare professionals on perinatal mental health related stigma reduction strategies.
A single group pre-test-post-test pilot study with no control group.
A university affiliated maternity hospital in Ireland
A convenience sample of registered midwives, nurses and doctors (n = 60) recruited from October 2020-January 2021.
A twenty-minute video-based educational intervention.
Respondents (n = 60) completed a pre-test (time point one) and post-test (time point-two) questionnaire, and a three-month follow-up post-test questionnaire (time point-three) (n = 39). The questionnaire included the Mental Illness Clinicians' Attitudes Scale, Reported and Intended Behaviour Scale, Reynolds Empathy Scale and open-ended questions. Wilcoxon Signed Rank Test was selected to evaluate the pre-test post-test scores.
The difference in mean Mental Illness: Clinicians' Attitudes-4 scores were statistically significant between time points one and three (z = 3.27, df=36, P = 0.0007) suggesting more positive attitudes towards people with mental health conditions after the intervention. The mean total score for the Reported and Intended Behaviour Scale increased from 18.7 (SD 1.87) at time point one to 19.2 (SD 1.60) at time point two (z= -3.368, df=59, P = 0.0004) suggesting an increase in positive intended behaviours towards those with mental health issues immediately following the intervention. These findings were also corroborated by responses to open-ended survey questions.
Further research with a larger sample of healthcare professionals evaluated over a longer period would provide further evidence for the sustainability of the intervention.
: A video-based intervention can increase healthcare professionals’ knowledge of perinatal #mentalhealth related stigma reduction strategies @Journal. Link to article
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