bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of rough initial scan for high-precision automatic 3D scanning
Authors: Seo Ji Hyun , Lee Inhwan Dennis , Yoo Byounghyun
Published: August 2021

Herein, we present an efficient method for the high-precision automatic 3D scanning of unknown objects for mechanical parts. Our method comprises two phases, namely a rough initial scan and a precision scan. The goal of the rough initial scan is to scan the rough shape rapidly and to provide scan data for the precision scan, thereby reducing the duration of the entire process. Researchers have attempted to provide rough information regarding an object before precision scanning, e.g. by building a rough three-dimensional (3D) model using 2D images or capturing the shape in advance using a low-accuracy scanner with a larger view frustum. However, our two-phase scanning method uses a single type of high-precision scanner for scanning the rough shape and also for the precision scan, which comes afterwards. In the rough initial scan phase, the next scanning view is determined based on the scan data captured by the latest view, eventually forming helical shape movement. In this study, we apply the two-phase scan method to 18 types of models in a virtual 3D scanning environment. For diverse configurations, the model size is adjusted from small to large relative to the virtual scanner’s view frustum, and the number of next best views calculated per iteration during the precision scan phase is adjusted. We demonstrate that the rough initial scan provides a certain amount of scan data rapidly regardless of the model size and shape. Furthermore, we demonstrate that the two scan methods complement each other, thereby reducing the overall process time and workload.
DASC-21: a novel geriatric assessment for discriminating best supportive care in older patients with inoperable advanced non-small cell lung cancer
Authors: Yamamoto Hiroshi , Sazuka Manami , Ishibashi Masayuki , Nogimori Chiemi , Takada Kazufumi , Hamaya Hironobu , Yamada Hirokazu , Awata Shuichi
Published: August 2021

Objective

This study investigated whether the Dementia Assessment Sheet for the Community-based Integrated Care System is useful for decision-making or problem detection in the treatment and care of older patients with inoperable advanced non-small cell lung cancer compared with the current standard model using performance status.

Methods

This study retrospectively examined 1595 cases admitted to the Department of Respiratory Medicine at the Tokyo Metropolitan Geriatric Hospital between 26 July 2016 and 28 January 2020. Among these, 29 and 31 patients who received pharmacotherapies and best supportive care were extracted, respectively. The performance in identifying best supportive care using the Dementia Assessment Sheet for the Community-based Integrated Care System was evaluated in comparison with performance status. The ability to detect impairments in each Dementia Assessment Sheet for the Community-based Integrated Care System domain was also assessed.

Results

The Dementia Assessment Sheet for the Community-based Integrated Care System total score had an area under the curve of 0.831 (95% confidence interval, 0.694–0.914), which was statistically equivalent to performance status. The discriminatory cut-off value for identification of best supportive care was set at 29 with a sensitivity and specificity of 0.742 and 0.897, respectively. Dementia Assessment Sheet for the Community-based Integrated Care System total score showed good concordance with performance status especially when reported by family members or caregivers. Deficits other than activities of daily living were recognized (2.8–19.4%) in patients with good performance status. Impairments were more frequently detected when reported by family members or caregivers.

Conclusions

The Dementia Assessment Sheet for the Community-based Integrated Care System discriminates the best supportive care for older patients with inoperable advanced non-small cell lung cancer. Moreover, it can identify vulnerabilities especially when reported by family members or caregivers that cannot be detected by performance status.
Quantification of the temperature equilibrium time of the cavity in parallel-plate-type ionization chambers by thermal analysis
Authors: Fuse Hiraku , Hirota Soma , Fujisaki Tatsuya , Abe Shinji , Yasue Kenji , Hanada Koichi , Tomita Fumihiro
Published: August 2021

Temperature corrections are necessary to account for the varying mass of air in the cavity volume of a vented ionization chamber. The temporal response resulting from temperature changes in a cylindrical and/or Farmer-type ionization chamber, which is the standard dosimeter, has been thoroughly discussed by some researchers. The purpose of this study was to characterise and analyse the dependence of the cavity air temperature of the parallel-plate-type ionization chamber on changes in the ambient temperature. Ionization chambers NACP-02 (IBA Dosimetry, GmbH) and Advanced Markus TN34045 (PTW, Freiburg) were modelled using thermal analysis software to present the temperature equilibrium time and the entire ionization chamber temperature distribution. The temporal response of each ionization chamber was measured for comparing the calculation results of the thermal analysis. The ionization chamber cavities of NACP-02 and TN34045 reached complete equilibrium in 670 and 750 s, respectively. Heat transfer occurred faster at the centre of the front wall of TN34045 than at the outside of the centre except for the edges. Further, the non-uniformity of temperature in the cavity was in the range of 24.2–24.8°C for NACP-02 and 23.7–24.4°C for TN34045 at 200 s after the ionization chamber was installed in the water phantom. The previous proposal to wait for about 15 mins after submerging the chamber in a water phantom before the measurement is demonstrated to be appropriate for parallel-plate-type ionization chambers.
Adherence to a Balanced Approach to Massive Transfusion in Combat Casualties
Authors: April Michael D , Fisher Andrew D , Hill Ronnie , Rizzo Julie A , Mdaki Kennedy , Bynum James , Schauer Steven G
Published: August 2021

Background

Hemorrhage is the most common cause of potentially preventable death on the battlefield. Balanced resuscitation with plasma, platelets, and packed red blood cells (PRBCs) in a 1:1:1 ratio, if whole blood (WB) is not available, is associated with optimal outcomes among patients with hemorrhage. We describe the use of balanced resuscitation among combat casualties undergoing massive transfusion.

Materials and Methods

We conducted a secondary analysis of data from the Department of Defense Trauma Registry (DODTR) spanning encounters from January 1, 2007, to March 17, 2020. We included all casualties who received at least 10 units of either PRBCs or WB. We categorized casualties as recipients of plasma-balanced resuscitation if the ratio of plasma to PRBC units was 0.8 or greater; similarly, we defined platelet-balanced resuscitation as a ratio of platelets to PRBC units of 0.8 or greater. We portrayed these populations using descriptive statistics and compared characteristics between non-balanced and balanced resuscitation recipients for both plasma and platelets.

Results

We identified 28,950 encounters in the DODTR with documentation of prehospital activity. Massive transfusions occurred for 2,414 (8.3%) casualties, among whom 1,593 (66.0%) received a plasma-balanced resuscitation and 1,248 (51.7%) received a platelet-balanced resuscitation. During the study period, 962 (39.8%) of these patients received a fully balanced resuscitation with regard to both the plasma:PRBC and platelet:PRBC ratios. The remaining casualties did not undergo a balanced resuscitation.

Conclusions

While a majority of massive transfusion recipients received a plasma-balanced and/or platelet-balanced resuscitation, fewer patients received a platelet-balanced resuscitation. These findings suggest that more emphasis in training and supply may be necessary to optimize blood product resuscitation ratios.
GALExtin: an alternative online tool to determine the interstellar extinction in the Milky Way
Authors: Amôres Eduardo B , Jesus Ricardo M , Moitinho André , Arsenijevic Vladan , Levenhagen Ronaldo S , Marshall Douglas J , Kerber Leandro O , Künzel Roseli , Moura Rodrigo A
Published: August 2021

Estimates of interstellar extinction are essential in a broad range of astronomical research. In the last decades, several maps and models of the large-scale interstellar extinction in the Galaxy have been published. However, these maps and models have been developed in different programming languages, with different user interfaces and input/output formats, which makes using and comparing results from these maps and models difficult. To address this issue, we have developed a tool called GALExtin (http://www.galextin.org), which estimates interstellar extinction based on both available 3D models/maps and 2D maps. The user only needs to provide a list with coordinates (and distance) and to choose a model/map. GALExtin will then provide an output list with extinction estimates. It can be implemented in any other portal or model that requires interstellar extinction estimates. Here, a general overview of GALExtin is presented, along with its capabilities, validation, performance and some results.
shaping the gas: understanding gas shapes in dark matter haloes with interpretable machine learning
Authors: Machado Poletti Valle Luis Fernando , Avestruz Camille , Barnes David J , Farahi Arya , Lau Erwin T , Nagai Daisuke
Published: August 2021

The non-spherical shapes of dark matter and gas distributions introduce systematic uncertainties that affect observable–mass relations and selection functions of galaxy groups and clusters. However, the triaxial gas distributions depend on the non-linear physical processes of halo formation histories and baryonic physics, which are challenging to model accurately. In this study, we explore a machine learning approach for modelling the dependence of gas shapes on dark matter and baryonic properties. With data from the IllustrisTNG hydrodynamical cosmological simulations, we develop a machine learning pipeline that applies XGBoost, an implementation of gradient-boosted decision trees, to predict radial profiles of gas shapes from halo properties. We show that XGBoost models can accurately predict gas shape profiles in dark matter haloes. We also explore model interpretability with the SHapley Additive exPlanations (shap), a method that identifies the most predictive properties at different halo radii. We find that baryonic properties best predict gas shapes in halo cores, whereas dark matter shapes are the main predictors in the halo outskirts. This work demonstrates the power of interpretable machine learning in modelling observable properties of dark matter haloes in the era of multiwavelength cosmological surveys.
Extinct crane-like birds (Eogruidae and Ergilornithidae) from the Cenozoic of Central Asia are indeed ostrich precursors
Authors: Mayr Gerald , Zelenkov Nikita
Published: August 2021

We describe new fossils from the late Eocene of Mongolia, which show that the crane-like Eogruidae and Ergilornithidae are stem group representatives of the Struthioniformes (ostriches). Currently, both taxa are unanimously assigned to the neognathous Gruiformes (cranes and allies). However, ergilornithids show a progressive reduction of the second toe, and a few earlier authors likened these birds to ostriches, which are the only extant birds with just 2 toes. So far, eogruids and ergilornithids were mainly known from hindlimb bones from the Cenozoic of Asia, and here we provide important new data on the skeletal anatomy of these birds. A partial skull exhibits characteristic features of palaeognathous birds, and ostriches in particular. In its distinctive shape, it furthermore closely resembles the skull of the Eocene palaeognathous Palaeotididae, which are here also considered to be stem group representatives of the Struthioniformes. A femur from the late Eocene of Mongolia likewise corresponds to that of ostriches in derived traits, whereas cervical vertebrae exhibit features of neognathous birds. The fossils suggest that true ostriches (crown group Struthionidae) originated in Asia, and the Neognathae-like morphology of some bones opens a new perspective on the evolution of skeletal characteristics of palaeognathous birds.
Interventions for Depressive Symptoms in People Living with Chronic Pain: A Systematic Review of Meta-Analyses
Authors: Cheng Darren K , Lai Ka Sing Paris , Pico-Espinosa Oscar Javier , Rice Danielle B , Chung Chadwick , Modarresi Golale , Sud Abhimanyu
Published: August 2021

Objective

This review investigated the effectiveness of clinical interventions on depressive symptoms in people with all types of chronic pain.

Methods

We searched seven electronic databases and reference lists on September 15, 2020, and included English-language, systematic reviews and meta-analyses of trials that examined the effects of clinical interventions on depressive outcomes in chronic pain. Two independent reviewers screened, extracted, and assessed the risk of bias. PROSPERO registration: CRD42019131871.

Results

Eighty-three reviews were selected and included 182 meta-analyses. Data were summarized visually and narratively using standardized mean differences with 95% confidence intervals as the primary outcome of interest. A large proportion of meta-analyses investigated fibromyalgia or mixed chronic pain, and psychological interventions were most commonly evaluated. Acceptance and commitment therapy for general chronic pain, and fluoxetine and web-based psychotherapy for fibromyalgia showed the most robust effects and can be prioritized for implementation in clinical practice. Exercise for arthritis, pharmacotherapy for neuropathic pain, self-regulatory psychotherapy for axial pain, and music therapy for general chronic pain showed large, significant effects, but estimates were derived from low- or critically low-quality reviews.

Conclusions

No single intervention type demonstrated substantial superiority across multiple pain populations. Other dimensions beyond efficacy, such as accessibility, safety, cost, patient preference, and efficacy for non-depressive outcomes should also be weighed when considering treatment options. Further effectiveness research is required for common pain types such as arthritis and axial pain, and common interventions such as opioids, anti-inflammatories and acupuncture.
Monetary Policy Risk: Rules versus Discretion
Authors: Backus David K , Chernov Mikhail , Zin Stanley E , Zviadadze Irina
Published: August 2021

Long-run asset pricing restrictions in a macro term structure model identify discretionary monetary policy separately from a policy rule. We find that policy discretion is an important contributor to aggregate risk. In addition, discretionary easing coincides with good news about the macroeconomy in the form of lower inflation, higher output growth, and lower risk premiums on short-term nominal bonds. However, it also coincides with bad news about long-term financial conditions in the form of higher risk premiums on long-term nominal bonds. Shocks to the rule correlate with changes in the yield curve’s level. Shocks to discretion correlate with changes in its slope.
Miocene Climate and Habitat Change Drove Diversification inBicyclus, Africa’s Largest Radiation of Satyrine Butterflies
Authors: Aduse-Poku Kwaku , van Bergen Erik , Sáfián Szabolcs , Collins Steve C , Etienne Rampal S , Herrera-Alsina Leonel , Brakefield Paul M , Brattström Oskar , Lohman david J , Wahlberg Niklas
Published: August 2021

Compared to other regions, the drivers of diversification in Africa are poorly understood. We studied a radiation of insects with over 100 species occurring in a wide range of habitats across the Afrotropics to investigate the fundamental evolutionary processes and geological events that generate and maintain patterns of species richness on the continent. By investigating the evolutionary history of Bicyclus butterflies within a phylogenetic framework, we inferred the group’s origin at the Oligo-Miocene boundary from ancestors in the Congolian rainforests of central Africa. Abrupt climatic fluctuations during the Miocene (ca. 19–17 Ma) likely fragmented ancestral populations, resulting in at least eight early-divergent lineages. Only one of these lineages appears to have diversified during the drastic climate and biome changes of the early Miocene, radiating into the largest group of extant species. The other seven lineages diversified in forest ecosystems during the late Miocene and Pleistocene when climatic conditions were more favorable—warmer and wetter. Our results suggest changing Neogene climate, uplift of eastern African orogens, and biotic interactions have had different effects on the various subclades of Bicyclus, producing one of the most spectacular butterfly radiations in Africa. [Afrotropics; biodiversity; biome; biotic interactions; Court Jester; extinction; grasslands; paleoclimates; Red Queen; refugia forests; dependent-diversification; speciation.]
A qualitative study on retailer experiences with Philadelphia’s sweetened beverage tax
Authors: Hua Sophia V , Uzwiak Beth , Hudgins Anastasia , Peterhans Ana , Lawman Hannah G , Bleich Sara N , Falbe Jennifer , Roberto Christina A
Published: August 2021

The Philadelphia Beverage Tax was implemented on January 1, 2017 for some sugar- and artificially-sweetened beverages. Few qualitative studies have assessed retailers’ reactions to beverage taxes. We aimed to understand food retailers’ knowledge and attitudes about the Philadelphia beverage tax and how they responded to it with the goal of informing the framing and implementation of beverage taxes in other interested jurisdictions. Researchers conducted semi-structured interviews with retailers within Philadelphia before (n = 15) and after (n = 11) the Philadelphia Beverage Tax was implemented. Purposeful sampling was used to recruit participants with different store locations and customer base characteristics. A priori codes based on the interview guide were used to organize data, and analytic memos were developed and reviewed to identify themes that emerged within the data using a grounded theory approach. Five themes emerged: (a) concerns about the tax purpose, amount, and use of revenue; (b) concerns about the tax’s impact on finances and business operations; (c) business strategies implemented to lessen financial burden of the tax; (d) perceptions of customer responses to the tax based on income; and (e) confusion around tax implementation. Results highlighted ways to improve implementation. Retailers in Philadelphia implemented various strategies to offset negative effects on taxed beverage sales. Cities implementing a beverage tax would benefit from investment in educational outreach and support to business owners prior to tax implementation and ensure transparency in how tax revenue will be spent.
Using Individual Residents’ Learning Trajectories to Better Understand the Impact of Gaps in Practice
Authors: Scott Stephanie A. , Van Eyk Nancy , Eva Kevin
Published: August 2021

Purpose

To optimize learning, health professional training programs need to achieve the right balance between depth of practice (gaining more experience with particular skills) and breadth of practice (spreading experience across an array of activities). Better understanding how training for a particular skill set is impacted by periods of focus on a different skill set would allow improved curriculum and assessment design, thereby enhancing the efficiency of training and effectiveness of care. To this end, learning curves were used to compare performance in surgery after prolonged periods of practice to performance after gaps in surgical training.

Method

Daily operative assessments from the Dalhousie obstetrics and gynecology program were analyzed retrospectively and learning curves were generated. In addition to examining the variability in learning trajectories, the impact of gaps was systematically assessed by comparing resident scores after 2 successive months in which they were not assessed operatively to those collected after 2 successive months in which they were assessed at least once.

Results

Four thousand four hundred sixteen scores for 33 residents over a 10-year period were analyzed. Trajectories and peak performances were identified. Residents performed better during their third sequential month of being assessed (mean = 4.40, 95% CI = 4.33–4.46) relative to during months following a period of being away from the operating room for at least 2 months (mean = 4.21, 95% CI = 4.13–4.29; P < .01; d = 0.7). However, maximum performance achieved was more strongly related to the number of times residents experienced a gap in training (r = 0.50) than to the number of times residents experienced 3 consecutive months of training (r = 0.25).

Conclusions

Distinct patterns of development exist for individual residents. Time away from surgical practice and assessment negatively impacted short-term performance, but may improve long-term learning trajectories. This speaks to the value of spaced education and is important for the design of longitudinal skills-based training programs.
The Cognitive Load of Inpatient Consults: A Convergent Parallel Mixed Methods Study Using the Consult Cognitive Load Instrument
Authors: Brondfield Sam , Lee Kewchang , O’Sullivan Patricia S.
Published: August 2021

Purpose

Consultation is crucial for patient care and a primary responsibility of fellows. Understanding the cognitive load associated with the complex skill of consultation would enhance fellow learning. The authors aimed to determine themes describing the fellow experience during inpatient consults specifically, align these themes with Consult Cognitive Load (CCL) scores, and identify strategies to manage cognitive load to enhance fellow education and performance, and, consequently, patient care.

Method

The authors studied 16 fellows using mixed methods. Fellows who accepted an invitation completed an inpatient consult followed by the CCL, a measure of cognitive load during consults, and an interview. Three authors conducted a thematic analysis. Member checks and triangulation supported theme trustworthiness. Subsequently, 3 authors rated the extent and cognitive demand of each theme expressed in each transcript. The authors measured interrater reliability and used Spearman correlation to describe the association of these ratings with CCL scores. The authors examined themes to identify strategies that educators might use.

Results

Analysis revealed 4 themes: “nature and scope,” which conceptually aligned with intrinsic load (IL); “leveraging resources,” which had elements of both IL and extraneous load (EL); “extraneous factors,” which aligned with EL; and “drivers,” which aligned with germane load (GL). Interrater reliability for extent and demand ratings ranged from 0.57 to 0.79. The correlation between “nature and scope” and IL was 0.37, “extraneous factors” and EL 0.71, and “drivers” and GL 0.32. “Leveraging resources” did not correlate with IL (0.06) or EL (−0.09). Potential strategies based on themes included offering level-appropriate assistance to match IL, focusing the fellow’s attention to reduce EL, and providing succinct teaching to promote GL.

Conclusions

This study provided deep insight into the fellow consult experience and suggested strategies for educators to guide consult learning. The theme “leveraging resources” merits further exploration.
How Teachers Adapt Their Cognitive Strategies When Using Entrustment Scales
Authors: Forte Milena , Morson Natalie , Mirchandani Natasha , Grundland Batya , Fernando Oshan , Rubenstein Warren
Published: August 2021

Purpose

Rater cognition is a field of study focused on individual cognitive processes used by medical teachers when completing assessments. Much has been written about the role of rater cognition in the use of traditional assessment scales. Entrustment scales (ES) are becoming the tool of choice for workplace-based assessments. It is not known how moving to an entrustment framework may cause teachers to adapt their cognitive rating strategies. This study aimed to explore this gap by asking teachers to describe their thinking when making rating decisions using a validated ES.

Method

Using purposive sampling, family medicine teachers supervising obstetrical care were invited to participate in cognitive interviews. Teachers were interviewed between December 2018 and March 2019 using retrospective verbal protocol analysis. They were asked to describe their experiences of rating residents in the last 6 months using new ES. Constructivist grounded theory guided data collection and analysis. Interviews were recorded, transcribed, and analyzed iteratively. A constant comparative approach was used to code and analyze the data until consensus was reached regarding emerging themes.

Results

There was variability in how teachers used the ES. Faculty describe several ways in which they ultimately navigated the tool to say what they wanted to say. Four key themes emerged: (1) teachers interpreted the anchors differently based on their cognitive framework, (2) teachers differed in how they were able to cognitively shift away from traditional rating scales, (3) teachers struggled to limit assessments to a report on observed behavior, and (4) teachers contextualized their ratings.

Conclusions

Variability in teachers’ interpretation of learner performance persists in entrustment frameworks. Rater’s individual cognitive strategies and how they observe, process, and integrate their thoughts into assessments form part of a rich picture of learner progress. These insights can be harnessed to contribute to decisions regarding readiness for unsupervised practice.
Artificial Intelligence in Undergraduate Medical Education: A Scoping Review
Authors: Lee Juehea , Wu Annie Siyu , Li David , Kulasegaram Kulamakan (Mahan)
Published: August 2021

Purpose

Artificial intelligence (AI) is a rapidly growing phenomenon poised to instigate large-scale changes in medicine. However, medical education has not kept pace with the rapid advancements of AI. Despite several calls to action, the adoption of teaching on AI in undergraduate medical education (UME) has been limited. This scoping review aims to identify gaps and key themes in the peer-reviewed literature on AI training in UME.

Method

The scoping review was informed by Arksey and O’Malley’s methodology. Seven electronic databases including MEDLINE and EMBASE were searched for articles discussing the inclusion of AI in UME between January 2000 and July 2020. A total of 4,299 articles were independently screened by 3 co-investigators and 22 full-text articles were included. Data were extracted using a standardized checklist. Themes were identified using iterative thematic analysis.

Results

The literature addressed: (1) a need for an AI curriculum in UME, (2) recommendations for AI curricular content including machine learning literacy and AI ethics, (3) suggestions for curriculum delivery, (4) an emphasis on cultivating “uniquely human skills” such as empathy in response to AI-driven changes, and (5) challenges with introducing an AI curriculum in UME. However, there was considerable heterogeneity and poor consensus across studies regarding AI curricular content and delivery.

Conclusions

Despite the large volume of literature, there is little consensus on what and how to teach AI in UME. Further research is needed to address these discrepancies and create a standardized framework of competencies that can facilitate greater adoption and implementation of a standardized AI curriculum in UME.
Training for Professional Uncertainty: Socialization of Medical Students Through the Residency Application Process
Authors: Russel Sarah M. , Geraghty Joseph R. , Renaldy Hilary , Thompson Trevonne M. , Hirshfield Laura E.
Published: August 2021

Purpose

Uncertainty in medical decision making is a well-described phenomenon, and numerous scholars have acknowledged and illustrated the process of training medical students to grapple with this aspect of medical practice. While clinical uncertainty has been defined previously, medical trainees face additional forms of uncertainty beyond the clinical setting that have not, as yet, been investigated empirically. One area in which uncertainty can manifest outside of the clinical setting is during professional development. Medical students face substantial stress and ambiguity throughout their training, with the residency application period representing a culmination of these pressures. Here, the authors examined medical students’ experiences during the residency application period and used these findings to define training for professional uncertainty.

Method

In 2018–2019, 6 focus groups of fourth-year medical students were conducted exploring students’ experiences during the residency application period, including but not limited to Step 2 Clinical Knowledge, away rotations, and securing letters of recommendation. The authors then used constructivist, phenomenological methods to analyze participant responses.

Results

Students frequently discussed challenges they faced during the residency application period. From these conversations, 2 themes were identified: (1) professional uncertainty related to career-based advice, which resulted from mixed messaging and inadequate information, and (2) professional uncertainty related to competing responsibilities, which students experienced when determining how to allocate a limited amount of time to multiple conflicting forces.

Conclusions

These results were used to define a novel concept—training for professional uncertainty. By navigating the residency application process, students learned to face various facets of professional uncertainty that they will continue to face throughout their careers. Since uncertainty can have many negative effects, including declining performance and burnout, defining professional uncertainty and training students to grapple with it is necessary to maximize their success throughout their careers.
Disruption and Dissonance: Exploring Constructive Tensions Within Research in Medical Education
Authors: Sukhera Javeed , Fung Cha-Chi , Kulasegaram Kulamakan
Published: August 2021

The academic medicine community has experienced an unprecedented level of disruption in recent years. In this context, the authors consider how the disruptions have impacted the state of research in medical education (RIME). The articles in this year’s RIME supplement reflect several constructive tensions that provide insight on future for the field. In this commentary, the authors discuss themes and propose a framework for the future. Recommendations include: normalizing help seeking during times of disruption and uncertainty, contextualizing the application of complex approaches to assessment, advancing and problematizing innovation, and recognizing the deeply embedded and systemic nature of inequities.
Postinjury Sepsis—Associations With Risk Factors, Impact on Clinical Course, and Mortality: A Retrospective Observational Study
Authors: Eriksson Jesper , Lindström Ann-Charlotte , Hellgren Elisabeth , Friman Ola , Larsson Emma , Eriksson Mikael , Oldner Anders
Published: August 2021

OBJECTIVES:

Overall outcomes for trauma patients have improved over time. However, mortality for postinjury sepsis has been reported to be unchanged. Estimate incidence of and risk factors for sepsis in ICU patients after major trauma and the association between sepsis, mortality, and clinical course.

DESIGN, SETTING, AND PATIENTS:

ICU in a large urban trauma center in Sweden with a well-developed trauma system. Retrospective cohort study of trauma patients admitted to the ICU for more than 24 hours were included.

MEASUREMENTS AND MAIN RESULTS:

Primary outcome measure was 30-day mortality. Secondary outcomes were 1-year mortality and impact on clinical course. In total, 722 patients with a median Injury Severity Score of 26 (interquartile range, 18–38) were included. Incidence of sepsis was 22%. Septic patients had a four-fold increase in length of stay and need for organ supportive therapy. The overall 30-day mortality rate was 9.3%. After exclusion of early trauma-related deaths in the first 48 hours, the 30-day mortality rate was 6.7%. There was an association between sepsis and this adjusted 30-day mortality (day 3 odds ratio, 2.1 [95% CI, 1.1–3.9]; day 4 odds ratio, 3.1 [95% CI, 1.5–6.1]; day 5 odds ratio, 3.0 [95% CI, 1.4–6.2]). Septic patients had a 1-year mortality of 17.7% (nonseptic 11.0%). Development of sepsis was independently associated with age, spine and chest injury, shock, red cell transfusion, and positive blood alcohol concentration at admission. The risk of sepsis increased, in a dose-dependent manner, with the number of transfusions.

CONCLUSIONS:

Postinjury sepsis was associated with a complicated clinical course and with mortality after exclusion of early, trauma-related deaths.
Caregivers' Technology Acceptance of an In-Home Care Management App
Authors: Wen Tzu-Ning , Li Hao-Ming , Hsu Tzu-Chuan , Chang Po-Lun
Published: August 2021

Taiwan faces challenges in providing long-term family care as its population rapidly ages. This study aimed to construct a health application that could effectively meet family caregivers' needs in providing home care. Mixed methods were adopted to explore their acceptance of the application, as well as to gather their suggestions for improving the application. A nonrandomized controlled group pretest–posttest design was utilized. The participants were family caregivers who were recruited via purposive sampling at a regional hospital in Taipei, Taiwan. The caregivers used the application to monitor and manage the health of those they were caring for. Elderly family caregivers scored 1.57 and 1.16 points higher than their middle-aged counterparts in terms of performance expectancy (0.61-2.53, P = .01) and effort expectancy (0.25-2.06, P = .01), respectively. The caregivers opined that it was convenient to use the application for managing the health data of their patients, and resources and solutions for overcoming problems when using the application were easily within their reach. They also suggested that relevant information for promoting patient mental health could also be included in the application. Thus, the software is acceptable to all the family caregivers regardless of age, indicating that it can assist family caregivers in the future in performing home care management.
A Comparison of Voice Recognition Program and Traditional Keyboard Charting for Nurse Documentation
Authors: Mayer LeAnn , Xu Dongjuan , Edwards Nancy , Bokhart Gordon
Published: August 2021

The purposes of this study are threefold: (1) compare the document times between a voice recognition system and keyboard charting, (2) compare the number of errors between the two methods, and (3) identify factors influencing documentation time. Voice recognition systems are considered a potential solution to decrease documentation time. However, little is known to what extent voice recognition systems can save nurses' documentation time. A pilot, simulation study was conducted using a voice recognition system and keyboard charting with 15 acute care nurses. A crossover method with repeated measures was utilized. Each nurse was given two simple and two complex assessment scenarios, assigned in random order, to document using both methods. Paired t-tests and multivariate linear regression models were used for data analysis. The voice recognition method saved the nurses 2.3 minutes (simple scenario) and 6.1 minutes (complex scenario) on average and was statistically significant (P < .001). There were no significant differences in errors or factors identified influencing documentation times. Eighty percent reported a preference of using voice recognition systems, and 87% agreed this method helped speed up charting. This study can show how a voice recognition system can improve documentation times compared with keyboard charting while still having thorough documentation.
Learning Outcomes of Digital Learning Interventions in Higher Education
Authors: Sormunen Marjorita , Heikkilä Asta , Salminen Leena , Vauhkonen Anneli , Saaranen Terhi
Published: August 2021

Implementing digital technologies has become a policy priority worldwide among all types of education. The COVID-19 pandemic has further accelerated educational institutions' efforts to reorganize their teaching and introduce new digital learning technologies. Although using digital technologies in higher education, including nursing, is considered a modern and innovative way of teaching and learning, uncertainty exists concerning these technologies' actual usefulness in achieving positive learning outcomes. The aim of this scoping review was to examine the current evidence related to the effects of using digital technologies on learning outcomes in higher education. The authors searched five electronic databases for relevant studies and used a scoping review method to analyze and synthesize the evidence. Eighty-six articles from six disciplines met the selection criteria. As a key finding, the outcomes of the interventions were mainly positive. Increased professional knowledge, skills, and attitudes reflect the advancement of professional competence. Academic, collaborative, and study skills, in turn, contribute to general competence development. Our findings suggest that digital technology has the potential to improve learning in various disciplines.
Facilitating the Implementation of Standardized Care Plans in Municipal Healthcare
Authors: Østensen Elisabeth , Hardiker Nicholas Richard , Hellesø Ragnhild
Published: August 2021

Standardized care plans have the potential to enhance the quality of nursing records in terms of content and completeness, thereby better supporting workflow, easing the documentation process, facilitating continuity of care, and permitting systematic data gathering to build evidence from practice. Despite these potential benefits, there may be challenges associated with the successful adoption and use of standardized care plans in municipal healthcare information practices. Using a participatory approach, two workshops were conducted with nurses and nursing leaders (n = 11) in two Norwegian municipalities, with the objective of identifying success criteria for the adoption and integration of standardized care plans into practice. Three themes were found to describe the identified success criteria: (1) “facilitating system level support for nurses' workflow”; (2) “engaged individuals creating a culture for using standardized care plans”; and (3) “developing system level safety nets.” The findings suggest success criteria that could be useful to address to facilitate the integration of standardized care plans in municipal healthcare information practice and provide useful knowledge for those working with implementation and further development of standardized care plans.
Coronavirus disease 2019 vaccines: landscape of global studies and potential risks
Authors: Jiang Hu-Da-Chuan , Tao Yan-Yang , Jia Si-Yue , Li Jing-Xin , Zhu Feng-Cai
Published: August 2021

With the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, the importance of vaccines in epidemic prevention and public health has become even more obvious than ever. However, the emergence of multiple severe acute respiratory syndrome coronavirus 2 variants worldwide has raised concerns about the effectiveness of current COVID-19 vaccines. Here, we review the characteristics of COVID-19 vaccine candidates in five platforms and the latest clinical trial results of them. In addition, we further discuss future directions for the research and development of the next generation of COVID-19 vaccines. We also summarize the serious adverse events reported recently after the large-scale vaccination with the current COVID-19 vaccines, including the thromboembolism caused by the AstraZeneca and Johnson & Johnson vaccines.
Sepsis Hospitalizations With Versus Without Cancer
Authors: Sharma Aditi , Nguyen Paul , Taha Muhanad , Soubani Ayman O.
Published: August 2021

Background:

Sepsis and cancer continue to be one of the leading causes of death in the United States. Concomitantly, hospitalizations for sepsis with underlying cancer over the years have shown a decrease in mortality. However, large-scale contemporary data on mortality trends in sepsis hospitalizations with underlying malignancy are lacking.

Research Question:

Are there any identifiable trends in patients hospitalized for sepsis with underlying malignancy versus without malignancy?

Study Design and Methods:

We performed a retrospective cohort study using the National Inpatient Sample database from 2008 to 2017 to identify sepsis hospitalizations with versus without cancer. Baseline variables and mortality trends were compared between the 2 groups.

Results:

Of the 19,160,734 sepsis hospitalizations identified between 2008 and 2017, 3,913,813 (20.4%) were associated with cancer and 15,246,921 (79.6%) did not have underlying malignancy. Compared with 2008 to 2009, the multivariable-adjusted odds ratio (aOR) of death was lower in 2016 to 2017 for both cancer (aOR: 0.55, 95% confidence interval [CI]: 0.53-0.57) and noncancer-associated (aOR: 0.55, 95% CI: 0.53-0.57) sepsis hospitalizations. The nonsignificant interaction term (P=0.2239) revealed that the rate of decline in mortality did not differ between the 2 groups. Stratification of the mortality in sepsis hospitalizations by various age groups revealed that the odds of death associated with cancer were highest in the younger population (18 to 44 y) with an aOR: 3.40, 95% CI: 3.24-3.57. The aOR: showed a declining trend with increasing age until cancer-associated admissions had slightly lower odds of mortality than the noncancer group at age 85 years old and older (aOR: 0.93, 95% CI: 0.91-0.95).

Conclusion:

In the 10-year study period, mortality in cancer and noncancer-associated sepsis hospitalizations has shown a declining trend. Furthermore, differences in mortality between the 2 groups decreased with increasing age.
Patient Outcomes After Applied Behavior Analysis for Autism Spectrum Disorder
Authors: Choi Kristen R. , Bhakta Bhumi , Knight Elizabeth A. , Becerra-Culqui Tracy A. , Gahre Teri L. , Zima Bonnie , Coleman Karen J.
Published: August 2021

Objectives:

The purpose of this study was to examine patterns of service receipt and patient outcomes for children receiving applied behavior analysis (ABA) for autism spectrum disorder (ASD) in an integrated health care system in which commercially insured children were covered by a state autism mandate.

Methods:

This retrospective, observational study used a random sample of children with ASD (3–17 yrs) who were members of a large integrated health care system in Southern California and referred for ABA between January 2016 and November 2018. From the 4145 children referred, a random stratified sample of 334 was selected to extract data from clinical reports over 24 months of services. The primary outcome measures were time in ABA and child adaptive behavior.

Results:

Thirteen percent of the sample never received ABA after referral. Of those who were referred for ABA, 66% initiated ABA and remained in services for 12 months, whereas less than half (46%) remained in services for 24 months. Having a history of special education was associated with longer time spent in ABA, whereas having a single parent was associated with discontinuation of ABA. A minority of children received a full ABA dose (28%), but the lowest functioning children still experienced clinically significant adaptive behavior gains after 24 months of ABA (p = 0.02).

Conclusion:

In a health system implementation of ABA for children with ASD, there were high rates of ABA discontinuation and low ABA dosing. These challenges may diminish the potential benefits of ABA, even in a context in which there is mandated commercial insurance coverage.
Comparing Water Absorption of Food and Drug Administration–Approved Hyaluronic Acid Fillers
Authors: Woodward Julie , Ranjit-Reeves Roshni , Katz David F. , Bernardini Francesco P. , Fagien Steven
Published: August 2021

BACKGROUND

To compare the water absorption of 12 FDA-approved hyaluronic acid (HA) facial fillers in vitro in conditions relevant to in vivo injection.

OBJECTIVE

The goal of this study was to provide long-term insight into an improved, tailored facial rejuvenation approach and to understand sequelae that could affect preoperative surgical planning.

METHODS

In 2 experiments, 12 FDA-approved HA fillers were loaded into test tubes with nonpreserved normal saline and then placed in a 94.5°F–96°F environment for 1 month to allow water absorption by passive diffusion. The test tubes were centrifuged so that the hydrated filler could pass to the bottom of the tube. The tubes were centrifuged for 12 minutes at 1,200 revolutions per minute in the first experiment and for 7 minutes in the second experiment. A blue dye was then instilled to demarcate the filler/saline interface.

RESULTS

There was variation in the water absorption of different HAs. Low absorption occurred in non–animal-stabilized hyaluronic acid.

CONCLUSION

The pattern of water absorption was similar in the 2 experiments. The results inform us about in vivo conditions and provide guidance for filler selection.
Mesh Repair of Rectus Diastasis for Abdominoplasty is Safer than Suture Plication
Authors: Sood Rachita , Janes Lindsay E. , Shah Nikita , Sasson Daniel C. , Ellis Marco F. , Dumanian Gregory A.
Published: August 2021

Background:

Concerns regarding infection, extrusion, and pain have traditionally precluded the use of mesh to treat severe rectus diastasis during abdominoplasty in the United States. We describe a mesh abdominoplasty technique, and we hypothesize that the complication rate using mesh is greater than the complication rate of suture plication.

Methods:

Inclusion criteria for mesh abdominoplasty were patients who (1) had retrorectus planar mesh for repair of rectus diastasis, (2) did not have concurrent ventral hernia, and (3) underwent skin tailoring. Patients who underwent rectus plication with suture, and met criteria 2 and 3 above were included in a sample of consecutive standard abdominoplasty patients. The primary endpoint was surgical site occurrence at any time after surgery, as determined with review of their office and hospital medical records. Secondary endpoints included surgical site infection, revision rates, postoperative course, and aesthetics assessed with their last set of office photographs.

Results:

Surgical site occurrence rate was 0% of the 40 patients in the mesh group and 19% of the 37 patients in the standard group (P = 0.005); rates of soft-tissue revision were 23% in the mesh group and 27% in the standard group (P = 0.84). As to aesthetics, the mesh abdominoplasty patients had mean statistically lower preoperative scores in comparison with the standard plication group (65.8 ± 11.6 versus 70.3 ± 11.4, P = 0.0013). The mesh group had a statistical improvement to 75.9 ± 12.6 (P < 0.0001), whereas the standard plication group improved to 82.5 ± 11.4 (P < 0.0001).

Conclusions:

Retrorectus mesh placement in a cohort of patients with severe rectus diastasis had a complication rate lower than that seen in a cohort of patients with less severe rectus diastasis, therefore negating our original hypothesis. This was done without compromising aesthetic improvement.