bluuebunny/crossref_metadata_2025_split huggingface dataset:
A view from the top: A qualitative exploration of top‐level health care leaders’ perceptions on the implementation of simulation‐based education in postgraduate medical education
Authors: Nayahangan Leizl Joy , Thinggaard Ebbe , Khan Farsana , Gustafsson Amandus , Mørcke Anne Mette , Dubrowski Adam , Hirshfield Laura E. , Konge Lars 
Published: October 2023

AbstractIntroductionAlthough there is substantial evidence supporting the benefits of simulation‐based education (SBE), its widespread and effective implementation remains challenging. The aim of this study was to explore the perceptions of top‐level health care leaders regarding SBE and the barriers and facilitators that influence its wide implementation as part of the postgraduate surgical curricula in Denmark.MethodsWe conducted semi‐structured interviews with top‐level health care leaders who were chosen based on their roles in ensuring high‐quality patient care delivery and developing strategies to achieve the goals of the entire health care system. The interview transcripts were translated into English, and a thematic approach was used to code and inductively analyse the data. We used the Consolidated Framework for Implementation Research to identify and understand the determinants to a successful implementation of SBE.ResultsWe interviewed 13 participants from different political and administrative levels. We found that the participants had limited knowledge about SBE, which highlighted a disconnection between these leaders and the educational environment. This was further compounded by a lack of effective communication and inadequate information dissemination between simulation centres and higher‐level organisations. While participants recognised the benefits of SBE for doctors in training, they expressed concerns about the implementation given the already strained health care system and limited resources. The need for evidence, particularly in the context of patient safety, was emphasised to facilitate SBE implementation. Although participants supported the implementation of SBE, it was unclear who should initiate action.DiscussionThis study highlighted the perspectives of top‐level health care leaders regarding SBE and identified the determinant factors for a successful implementation. Effective communication channels are crucial to enhance collaborations and reduce the disconnection between the different health care organisational levels. Strategic implementation processes, including the roles and responsibilities, should be defined and established. These will inform decisions regarding the implementation strategies to effectively integrate SBE into the residency training curricula.
Budget starting position matters: A “field‐in‐lab” experiment testing simulation engagement and budgetary preferences
Authors: Mohr Zach , Afonso Whitney 
Published: October 2023

AbstractBudget scholars have long theorized the impact of citizen engagement in the budget process. However, there is a void in the literature on modern types of engagement such as online budget simulations. Basic questions like what governments can do to increase the level of engagement and what effects such changes have on outcomes remain unanswered. Using a behavioral public budget and finance framework, we designed and tested an experiment with a local government budget simulation and varied the starting condition between balance, surplus, and deficit to assess the impact of starting condition on relevant outcomes of engagement and budgetary preferences. Results show that two measures of engagement and most budget preferences were influenced by the starting condition. Field‐in‐lab experiments like this one have the potential to further develop behavioral budget theory and be used to test online government platforms that are used by governments for engagement and many other purposes.
Review of pediatric combined heart‐liver transplantation: A roadmap to success
Authors: Lee Jason T. C. , Sarode Deepika , Emamaullee Juliet A. 
Published: October 2023

AbstractBackgroundCombined heart‐liver transplantation (CHLT) is a promising technique to address end stage organ failure in patients with concomitant heart failure and chronic liver disease. While most experience with CHLT has involved adult patients, the expanding population of children born with univentricular congenital heart disease who underwent the Fontan procedure and develop Fontan‐associated liver disease (FALD) has emerged as a growing indication for pediatric CHLT.MethodsCurrently, CHLT is performed at a select subset of experienced transplant centers, especially in the pediatric population.ResultsWhile technically demanding, CHLT may offer survival benefit when compared to heart transplant alone with decreased rejection of both synchronous allografts and equivalent outcomes with respect to waitlist time and post‐operative complications. Limitations in the technique can be attributed to need for an appropriate multidisciplinary care center, challenges with donor organ availability and allocation, and the complexity associated with patient selection and peri‐operative management.ConclusionIn this review, we summarize the history of CHLT, discuss patient selection, and highlight key facets of peri‐operative care in the pediatric population.
Investigating the skills of a preschool leader: A latent profile analysis
Authors: Held Lindsey L. , Gilpin Ansley T. , Xia Mengya 
Published: October 2023

AbstractIndividuals emerge as leaders across the lifespan; however, research investigating early childhood leaders is scant. This study assessed leadership in early childhood (N = 375) by using latent profile analysis of secondary data to examine how skill profiles are related to preschool leader scores. Skill profiles included scores for executive functioning, emotion regulation, imagination, theory of mind, vocabulary, and reception of prosocial behaviors (likeability). Six distinct profiles emerged with variation of high and low skill groupings. Four profiles with higher skill groupings also scored the highest on the leader construct but were not statistically different from each other. These findings support previous research that suggests that leaders may be identifiable in early childhood, and that there may be more than one pathway to early childhood leadership (i.e., differing skill combinations). With further research, these findings may have implications for curriculum development and the selection of peer models in clinical practice.
Medicaid expansions and private insurance “crowd‐out” (1999–2019)
Authors: Semprini Jason 
Published: October 2023

AbstractBackgroundRecent Medicaid expansions have rekindled the debate around private insurance “crowd‐out.” Prior research is limited by short‐time horizons and state‐specific analyses. Our study overcomes these limitations by evaluating 20 years of Medicaid expansions across the entire United States.MethodsWe obtain data from the U.S. Census Bureau for all U.S. states and District of Columbia for private insurance coverage rates of adults 18–64 for years 1999–2019. After estimating a naïve, staggered Two‐way fixed effects difference‐in‐differences regression model, we implement four novel econometric methods to diagnose and overcome threats of bias from staggered designs. We also test for pre‐treatment differential trends and heterogenous effects over time.ResultsOur findings suggest that Medicaid expansion was associated with a 1.5 percent‐point decline in private insurance rates (p < 0.001). We also observe significant heterogeneity over time, with estimates peaking 4 years after expansion.ConclusionsMedicaid expansions reduced private insurance rates. Future research should assess whether or how this crowd‐out may have affected consumer welfare or government budgets. Recognizing the crowd‐out should enable policymakers to make informed decisions regarding healthcare policy. The importance of a 1‐2 percent‐point crowd‐out, we leave for future research and debate.
Reflective practice in medicine: The hidden curriculum challenge
Authors: Ní Mhurchú Michelle , Cantillon Peter 
Published: October 2023

AbstractBackgroundDespite the known benefits of reflection in various health care professions, it is still not a thriving practice in medical education. The literature suggests that this may be due to tensions between epistemological tenets of reflection and biomedicine. Further research is needed into experiences of doctors as they implement reflection in medical education settings. We set out to explore how these experiences were influenced by hidden curricula to provide insights into personal and contextual features of medical settings influencing engagement in reflection.MethodsUsing an interpretative phenomenological analysis (IPA) approach, four semi‐structured qualitative interviews were conducted virtually. Participants were doctors who graduated from a postgraduate diploma in clinical education with core reflective practice components. Interviews were recorded, transcribed, coded and analysed using IPA. Opportunities to review and amend transcriptions were provided.FindingsThree superordinate themes were identified including epistemological divergence, fear of showing vulnerability and reflection volte‐face. Challenges in engaging in practices epistemologically different to predominant discourses in medicine were compounded by fears of vulnerability and a common antipathy towards reflection. All developed more accommodating perspectives towards reflection with shared experiences of a programme incorporating reflective practice.ConclusionThe hidden curriculum can have positive and negative impacts on doctors' engagement in reflection. In facilitating reflective practice for this group, we recommend assisting with awareness of ways of thinking and being in medicine, offering reassurance that reflection may initially feel like running contrary to predominant discourses and finally, role modelling openness to vulnerability to better integrate and promote meaningful engagement in reflection.
A Whole-Core Transient Thermal Hydraulic Model for Fluoride Salt-Cooled Reactors
Authors: Chandrasekaran Sriram , Garimella Srinivas 
Published: October 2023

Abstract
A thermal hydraulic model is developed for a solid pin-fueled fluoride-salt-cooled small modular advanced high temperature reactor (SmAHTR). This preconceptual SmAHTR was developed by the Oak Ridge National Laboratory (ORNL). For the fuel assembly configuration investigated in this study, the fuel and non-fuel pins are arranged in a hexagonal layout. The molten FLiBe salt coolant flows parallel to the bank of pins. A finite volume model is developed and used to compute temperatures in the solid regions (fuel and non-fuel pins, and the graphite reflectors) in the core. The temperature, flow, and pressure profiles for the coolant flowing through the pin bundles in the core are calculated using the conventional subchannel methodology. Pertinent closure relations are used to compute the hydraulic losses, momentum, and energy exchange between adjacent subchannels, and heat transfer between the solid and fluid regions. The resulting model can perform both steady-state and transient computations across the entire core. This fully implicit model also includes an adaptive time-stepping algorithm for automatic time-step adjustment. A preliminary code-to-code comparison demonstrates good agreement between the present subchannel-based model and a computational fluid dynamics (CFD)-based model for a transient case in which the core inlet flowrate varies with time. Following the code-to-code comparison, the thermal hydraulic model is used to analyze the protected loss of heat sink (P-LOHS) accident scenario. Key results such as the transient evolution of peak fuel, non-fuel, and coolant temperatures, and 3-D core temperature distribution are presented and discussed.
A Differential Error-Based Self-Triggered Model Predictive Control With Adaptive Prediction Horizon for Discrete Systems
Authors: He Ning , Chen Shuoji , Xu Zhongxian , Cheng Fuan , Li Ruoxia , Gao Feng 
Published: October 2023

Abstract
For discrete time nonlinear networked control systems, a novel self-triggered adaptive model predictive control (MPC) strategy is developed. Different from the existing self-triggered MPC methods that determine the triggering instants based on the difference between the optimal and real states at one single instant, the proposed approach updates the MPC system according to the differential form of the state error of two consecutive sampling moments to effectively reduce the computation and communication burden while maintaining the ideal control performance. In addition, this paper introduces a new adaptive prediction horizon mechanism to the self-triggered MPC, so that the amplitude of prediction horizon contraction is sufficiently large to further reduce the computational burden of the MPC method. Finally, the recursive feasibility and robust stability of this proposed strategy are proved strictly by theoretical analysis, and the simulation comparison results are shown to verify the proposed framework.
The Research for Quickly Measuring the Diameter and Roundness of Solder Balls Based on Machine Vision Technology
Authors: Wang Tongju , Liu Yahao , Zhang Wenqian , Lei Yongping , Lin Jian , Fu Hanguang , Lin Zipeng 
Published: October 2023

Abstract
Solder balls used in electronic packaging should have high dimensional and shape accuracy requirements to ensure the connection quality of solder balls during soldering. However, the existing solder ball detection methods were hard to measure the diameter and roundness in an integrated and fast manner. Therefore, a new method and device for measuring the diameter and roundness of solder balls was proposed based on machine vision technology, including detection device and software design. The experimental device could detect the parameters of at least 40 solder balls at a time. The solder ball image was preprocessed in the software system to improve the quality of the solder ball image, and then the Harris operator successfully detected the concave point on the bonded solder ball image and realized the solder ball separation based on the shortest path matching criterion. Compared with the scanning electron microscope (SEM) measurement value, the diameter and roundness of solder balls measured by the detection system were smaller than 3%.
Aerodynamics and Flowfield of Distributed Electric Propulsion Tiltwing During Transition With Deflected Trailing-Edge Flap
Authors: Lee T. , Ni T. , Lin G. 
Published: October 2023

Abstract
The aerodynamics and flowfield of a rectangular semiwing equipped with four four-bladed propellers and a 40%-chord full-span plain trailing-edge flap were investigated by using force balance and particle image velocimetry (PIV). The distributed electric propulsion (DEP) wing was tilted from zero to 90-deg angle of attack. The maximum lift coefficient, lift-curve slope, and stall angle of the DEP wing were found to increase significantly with increasing propeller rotation. The DEP wing also exhibited a gradual stall in contrast to the sudden stall of the baseline wing. The lift coefficient of the DEP wing positioned vertically at 90 deg was also found to be greatly increased with increasing propeller rotation. Regardless of the magnitude of propeller rotation, the general pattern and behavior of the lift curve were consistent. The deployment of the flap led to a further increase in the maximum lift coefficient and lift-curve slope but an earlier stall and an increased drag of the DEP wing as compared to the unflapped wing. The flap deflection also led to a lowered lift coefficient in the poststall angle-of-attack regime as compared to the unflapped DEP wing. Gurney flap was also employed to further increase the lift generation of the DEP wing. The lift augmentation produced by the propeller slipstream was supplemented by the PIV flowfield measurements.
Mitigation of Wave Force on a Tunnel in the Presence of Submerged Porous Plate Over Trench-Type Bottom Topography
Authors: Choudhary Sunita , Martha S. C. 
Published: October 2023

Abstract
Thin porous plates serve as an effective model for the construction of breakwater. Thus, the problem involving oblique wave interaction with a tunnel in the presence of a submerged horizontal porous plate over a trench-type bottom is investigated. In this article, for the mathematical formulation of the physical model, water wave potentials are defined using Havelock’s expansions and flow past over porous structure is modeled based on Darcy’s law. The advantage of the trench type of bottom and horizontal plate is studied through the numerical results of forces on the tunnel. The study reveals that more energy loss and less force on the tunnel are obtained if the porous effect parameter of the plate or the length of the plate is increased up to a moderated value of these parameters. Compared to the case without porous plate and trench-type bottom topography, there are significant changes in forces due to this porous breakwater and trench-type bottom topography. In addition, from the present results, it may be noted that the load on the submerged tunnel is reduced by adding a submerged horizontal porous plate and asymmetric trench, which is helpful in understanding the role of porous breakwaters and trenches in applications to ocean and coastal engineering.
A Mixed Zero-Equation and One-Equation Turbulence Model in Fluid-Film Thrust Bearings
Authors: Deng Xin 
Published: October 2023

Abstract
A thrust bearing is a rotary bearing that facilitates rotational movement between components and is specifically engineered to provide support for a load that is parallel to the axis of rotation. The generation of the inter-surface film pressure is attributed to the relative motion (rotation) of the surfaces, which results in the lubricant being drawn into the converging wedge formed between them. The interface between the unmovable and moving parts is demarcated by a slender layer of lubricating fluid, including but not limited to oil, water, air, or other process fluid. The conventional zero-equation model can be enhanced to achieve higher precision in forecasting and reduce dependence on empirical data, owing to its inherent limitations. A novel turbulence model that combines zero-equation and one-equation approaches has been developed and implemented in the recently introduced modeling tool package for thrust bearings. In the Prandtl one-equation turbulence model, the length scale is a necessary but undetermined term. A novel mixed model has been implemented utilizing the Prandtl one-equation along with a novel-length scale. The tool package is a Thermo-Hydrodynamic (THD) code that involves iterative computations between the Reynolds’ equation, turbulence equation, energy equation within the film, and conduction equation in pad and runner. The new model yields an eddy viscosity that exhibits a substantial level of proximity to both eddy viscosity transport (EVT) and direct numerical simulation (DNS), and exhibits significant enhancements in comparison to the traditional Ng–Pan zero-equation turbulence model.
Profiling daptomycin resistance among diverse methicillin-resistant
Staphylococcus aureus
lineages in China
Authors: Jiang Shengnan , Chen Mengzhen , Zhang Junxiong , Ba Xiaoliang , Zhang Hao , Hong Yueqin , Sun Lu , Wang Zhengan , Zhuang Hemu , Zhu Feiteng , Chen Yiyi , Wang Haiping , Zhao Feng , Chen Yan , Yu Yunsong , Ji Shujuan 
Published: October 2023

ABSTRACT

Daptomycin (DAP) is effective against methicillin-resistant
Staphylococcus aureus
(MRSA). However, reduced susceptibility to DAP in MRSA may lead to treatment failures. We aim to determine the distribution of DAP minimum inhibitory concentrations (MICs) and DAP heteroresistance (hDAP) among MRSA lineages in China. A total of 472 clinical MRSA isolates collected from 2015 to 2017 in China were examined for DAP susceptibility. All isolates (
n
= 472) were found to be DAP susceptible, but 35.17% (166/472) of them exhibited a high DAP MIC (MIC >0.5 µg/mL). The high DAP MIC group contained a larger proportion of isolates with a higher vancomycin or teicoplanin MIC (>1.5 µg/mL) than the low DAP MIC group (19.3% vs 7.8%,
P
< 0.001; 22.3% vs 8.2%,
P
< 0.001). We compared the clonal complex (CC) distributions and clinical characteristics in MRSA isolates stratified by DAP MIC. CC5 isolates were less susceptible to DAP (MIC
50
= 1 µg/mL) than CC59 isolates (MIC
50
= 0.5 µg/mL,
P
< 0.001). Population analysis profiling revealed that 5 of 10 ST5 and ST59 DAP-susceptible MRSA isolates investigated exhibited hDAP. The results also showed that CC5 MRSA with an
agrA
mutation (I238K) had a higher DAP MIC than those with a wild-type
agrA
(
P
< 0.001). The
agrA
-I238K mutation was found to be associated with
agr
dysfunction as indicated by the loss of δ-hemolysin production. In addition,
agr/psmα
defectiveness was associated with hDAP in MRSA. Whole-genome sequencing analysis revealed mutations in
mprF
and
walR
/
walK
in DAP-resistant subpopulations, and most DAP-resistant subpopulations (6/8, 75%) were stable. Our study suggests that the increased DAP resistance and hDAP in MRSA may threaten the effectiveness against MRSA infections.