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A study was conducted to develop a technical skills assessment tool for the training and development of challenge course facilitators. Researchers accessed two professional on-line listserves to collect a sample size of twenty-seven currently used technical skills assessment tools. The assessment tools were critically analysed by three independent reviewers. As a result, ten commonly assessed technical skills were identified. A rubric was then developed based on the ten technical skills. A Delphi panel consisting of seven challenge course professionals completed a total of four reviews and revisions of the rubric resulting in the Challenge Course Facilitator Technical Skills Assessment Tool.

Effective and safe liver‐directed gene therapy has great promise in treating a broad range of liver diseases. While adenoviral (Ad) vectors have been widely used for efficacious in vivo gene delivery, their translational utilities are severely limited due to the short duration of transgene expression and solicitation of host immune response. Used as a promising polymeric vehicle for drug release and nucleic acid delivery, carboxymethyl chitosan (CMC) is biocompatible, biodegradable, anti‐microbial, inexpensive, and easy accessible. Here, by exploiting its biocompatibility, controlled release capability and anti‐inflammatory activity, we investigated whether CMC can overcome the shortcomings of Ad‐mediated gene delivery, hence improving the prospect of Ad applications in gene therapy. We demonstrated that in the presence of optimal concentrations of CMC, Ad‐mediated transgene expression lasted up to 50 days after subcutaneous injection, and at least 7 days after intrahepatic injection. Histologic evaluation and immunohistochemical analysis revealed that CMC effectively alleviated Ad‐induced host immune response. In our proof‐of‐principle experiment using the CCl4‐induced experimental mouse model of chronic liver damage, we demonstrated that repeated intrahepatic administrations of Ad‐IL10 mixed with CMC effectively mitigated the development of hepatic fibrosis. Collectively, these results indicate that CMC can improve the prospect of Ad‐mediated gene therapy by diminishing the host immune response while allowing readministration and sustained transgene expression. [ABSTRACT FROM AUTHOR]

Background: Patients may experience adverse health outcomes when they are unable to manage medical bills. It is currently unknown, however, whether patients talk about cost in the context of medical imaging services they received.Materials and Methods: Retrospective qualitative analysis of twitter posts related to medical imaging and cost. Tweets were extracted from twitter, inclusion and exclusion criteria were applied, and tweets were categorized as either "positive" or "negative"; none were "neutral". A qualitative thematic analysis of all included tweets was performed to develop themes and topics expressed. A single tweet may have been assigned several different codes according to its content. A random sampling of the tweets from each topic were selected by the two reviewers, verified by the remaining reviewers, and quoted (Q).Results: Here, 9.8% (n = 99) of tweets relevant to medical imaging were included in the analysis. The majority had a negative sentiment (91%, n = 90) related to themes of (1) cost of care (47%, n = 42), (2) care delivery (23%, n = 21), (3) insurance Issues (23%, n = 21), and (4) need for information (7%, n = 6). A few positive tweets (9%, n = 9) were related to themes of (1) Gratitude (44%, n = 4), (2) Affordability (33%, n = 3), and (3) Better than expected (22%, n = 2).Conclusion: Among tweets related to medical imaging we found that 10% relate to cost and that these are overwhelmingly negative, mostly due to perceived high cost of care, deficient care delivery, and insurance issues. [ABSTRACT FROM AUTHOR]

What shapes the types of services terrorist and insurgent groups provide? Research on these organizations provides mounting evidence that understanding the nonviolent strategies of violent groups is critical to a complete picture of conflict dynamics. We add to this work, using a longitudinal measure of terrorist service provision coverage across a number of service sectors to evaluate hypotheses concerning the drivers of terrorist service provision to understand which services groups provide. Here, we are interested in understanding patterns of service provision: which groups provide services where, and whether and how that decision is reactive to the state context. Specifically we look to see if groups are likely to provide services as complements or substitutes to the state in the competition for constituents. We find terrorist groups challenge the state in service provision in less capital-intensive sectors, such as education, while avoiding competition in more capital-intensive sectors, such as healthcare. We also find service provision varies over a group's lifetime, likely in response to counterterrorism efforts. As a group ages and strengthens, it is also more likely to provide a broader array of services. Finally, we observe that service-providers tend to have longer lifespans. [ABSTRACT FROM AUTHOR]

Observing the structure and regeneration of the myelin sheath in peripheral nerves following injury and during repair would help in understanding the pathogenesis and treatment of neurological diseases caused by an abnormal myelin sheath. In the present study, transmission electron microscopy, immunofluorescence staining, and transcriptome analyses were used to investigate the structure and regeneration of the myelin sheath after end-to-end anastomosis, autologous nerve transplantation, and nerve tube transplantation in a rat model of sciatic nerve injury, with normal optic nerve, oculomotor nerve, sciatic nerve, and Schwann cells used as controls. The results suggested that the double-bilayer was the structural unit that constituted the myelin sheath. The major feature during regeneration was the compaction of the myelin sheath, wherein the distance between the 2 layers of cell membrane in the double-bilayer became shorter and the adjacent double-bilayers tightly closed together and formed the major dense line. The expression level of myelin basic protein was positively correlated with the formation of the major dense line, and the compacted myelin sheath could not be formed without the anchoring of the lipophilin particles to the myelin sheath. [ABSTRACT FROM AUTHOR]

What determines military effectiveness? Previous literature has examined factors such as military doctrine, culture, and capabilities, as well as regime type and civil–military relations, but has largely ignored military leadership quality. Competent military leaders positively influence battle outcomes by ensuring proper implementation of battleplans and quick reaction to an increasingly dynamic battlefield. This paper formally models the relationship between high-ranking military commanders and their immediate subordinates to examine the commander's ability to evaluate her personnel. I vary the ability of the subordinates to signal their commander to determine how different signaling structures influence what commanders may learn. This analysis reveals that commanders opt for less informative signals from subordinates as the military professionalizes, potentially impeding their ability to identify and remove incompetent subordinates. Leaving incompetent subordinates in command reduces the ability of the military to improve. Evidence from the US Army's leadership decisions after the Battle of Kasserine Pass and Operation Avalanche illustrates these results. [ABSTRACT FROM AUTHOR]

Artificial intelligence has become a ubiquitous term in radiology over the past several years, and much attention has been given to applications that aid radiologists in the detection of abnormalities and diagnosis of diseases. However, there are many potential applications related to radiologic image quality, safety, and workflow improvements that present equal, if not greater, value propositions to radiology practices, insurance companies, and hospital systems. This review focuses on six major categories for artificial intelligence applications: study selection and protocoling, image acquisition, worklist prioritization, study reporting, business applications, and resident education. All of these categories can substantially affect different aspects of radiology practices and workflows. Each of these categories has different value propositions in terms of whether they could be used to increase efficiency, improve patient safety, increase revenue, or save costs. Each application is covered in depth in the context of both current and future areas of work. Keywords: Use of AI in Education, Application Domain, Supervised Learning, Safety © RSNA, 2022., Competing Interests: Disclosures of Conflicts of Interest: Y.T. No relevant relationships. V.M. No relevant relationships. W.W. No relevant relationships. H.Z. No relevant relationships. A.P. Consulting fee or honorarium from QMC. N.B. No relevant relationships. M.H. No relevant relationships. E.K. Publications Ethics Committee for RSNA journals. N.S. Advisor to a resident who received an RSNA Research & Education Foundation grant. The project is entitled HL7-Shield: A Versatile HL7 Listener Software for Automated Follow-up Tracking; pending patent for HL-7 Shield (Emory University is applying for a software patent for an AI approach to findings notification, this author listed as contributor). I.B. No relevant relationships. J.G. Future of Work Grant NIH NIBIB MIDRC grant (not related to this work); associate editor and trainee editorial board lead for Radiology: Artificial Intelligence. H.T. Consultant for BioData Consortium and Sirona Medical; grant from Kheiron Medical for institution; owner of Lightbox AI., (2022 by the Radiological Society of North America, Inc.)

Purpose: To evaluate the relationship between Yttrium-90 (Y90) tumour dose and response rate in patients with hepatocellular carcinoma (HCC) who undergo Y90 radiation segmentectomy (Y90-RS) and to determine implication on overall survival (OS)., Materials and Methods: Post Y90-RS Bremsstrahlung single-photon emission computed tomography/CT of 105 HCC patients with 110 treatments performed with glass microspheres was retrospectively analysed. The dose-volume histogram of the targeted tumour was determined with commercially available dosimetry software. Tumour response at 3 months was evaluated using modified Response Evaluation Criteria in Solid Tumours. Tumour dose thresholds associated with the objective response with 80% specificity were then used to evaluate implication on OS using Kaplan-Meier estimation and log-rank analysis., Results: Tumour dose thresholds to predict objective response with 80% specificity were the following: maximum tumour dose (748 Gy), mean tumour dose (568 Gy), minimum tumour dose of 30% tumour volume (608 Gy), minimum tumour dose of 50% tumour volume (565 Gy), minimum tumour dose of 70% tumour volume (464 Gy) and minimum tumour dose of 100% tumour volume (213 Gy). These parameters all significantly predicted tumour response with areas under the ROC curve of >0.6. Mean tumour dose of ≥250 Gy predicted median OS of 43.67 vs. 17.87 months for others (P = 0.026). Minimum dose ≥180 Gy to 100% of tumour volume predicted median OS of 44.93 vs. 35.87 months for others (P = 0.043)., Conclusion: In patients with HCC undergoing Y90-RS, mean tumour dose ≥250 Gy and minimum tumour dose of ≥180 Gy to 100% of tumour volume are both significantly correlated with higher objective tumour response and prolonged survival., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Ovarian cancer is the third most common cancer and the second most common cause of gynecologic cancer death in women. Its routine clinical management includes surgical resection and systemic therapy with chemotherapeutics. While the first-line systemic therapy requires the combined use of platinum-based agents and paclitaxel, many ovarian cancer patients have recurrence and eventually succumb to chemoresistance. Thus, it is imperative to develop new strategies to overcome recurrence and chemoresistance of ovarian cancer. Repurposing previously-approved drugs is a cost-effective strategy for cancer drug discovery. The antiparasitic drug mebendazole (MBZ) is one of the most promising drugs with repurposing potential. Here, we investigate whether MBZ can overcome cisplatin resistance and sensitize chemoresistant ovarian cancer cells to cisplatin. We first established and characterized two stable and robust cisplatin-resistant (CR) human ovarian cancer lines and demonstrated that MBZ markedly inhibited cell proliferation, suppressed cell wounding healing/migration, and induced apoptosis in both parental and CR cells at low micromole range. Mechanistically, MBZ was revealed to inhibit multiple cancer-related signal pathways including ELK/SRF, NFKB, MYC/MAX, and E2F/DP1 in cisplatin-resistant ovarian cancer cells. We further showed that MBZ synergized with cisplatin to suppress cell proliferation, induce cell apoptosis, and blunt tumor growth in xenograft tumor model of human cisplatin-resistant ovarian cancer cells. Collectively, our findings suggest that MBZ may be repurposed as a synergistic sensitizer of cisplatin in treating chemoresistant human ovarian cancer, which warrants further clinical studies.