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Introduction: Emergency medicine (EM) residency programs have variable approaches to educating residents on recognizing and managing healthcare disparities. We hypothesized that our curriculum with resident-presented lectures would increase residents’ sense of cultural humility and ability to identify vulnerable populations. Methods: At a single-site, four-year EM residency program with 16 residents per year, we designed a curriculum intervention from 2019-2021 where all second-year residents selected one healthcare disparity topic and gave a 15-minute presentation overviewing the disparity, describing local resources, and facilitating a group discussion. We conducted a prospective observational study to assess the impact of the curriculum by electronically surveying all current residents before and after the curriculum intervention. We measured attitudes on cultural humility and ability to identify healthcare disparities among a variety of patient characteristics (race, gender, weight, insurance, sexual orientation, language, ability, etc). Statistical comparisons of mean responses were calculated using the Mann-Whitney U test for ordinal data. Results: A total of 32 residents gave presentations that covered a broad range of vulnerable patient populations including those that identify as Black, migrant farm workers, transgender, and deaf. The overall survey response was 38/64 (59.4%) pre-intervention and 43/64 (67.2%) post-intervention. Improvements were seen in resident self-reported cultural humility as measured by their responsibility to learn (mean responses of 4.73 vs 4.17; P < 0.001) and responsibility to be aware of different cultures (mean responses of 4.89 vs 4.42; P < 0.001). Residents reported an increased awareness that patients are treated differently in the healthcare system based on their race (P < 0.001) and gender (P < 0.001). All other domains queried, although not statistically significant, demonstrated a similar t rend. Conclusion: This study demonstrates increased resident willingness to engage in cultural humility and the feasibility of resident near-peer teaching on a breadth of vulnerable patient populations seen in their clinical environment. Future studies may query the impact this curriculum has on resident clinical decision-making.

Item does not contain fulltext PURPOSE: In the Netherlands yearly more than 5000 patients are diagnosed with non-muscle invasive bladder cancer (NMIBC). With a specificity of 88.0% and a negative predictive value (NPV) for high grade NMIBC of 99.3%, the Bladder EpiCheck (BE) urine test may be used in NMIBC to reduce the burden of follow-up cystoscopies. METHODS: In this study a cost analysis of the BE follow-up strategy in the Dutch healthcare system was performed. In half of the follow-up appointments, BE was used as a rule-in for cystoscopy. In addition, the possible delay in recurrence detection was estimated. A cost calculation tool was developed using Microsoft Excel. RESULTS: The BE strategy results in an estimated cost reduction of 8%, 4% and 9% in low, intermediate and high risk patients, respectively. In the Netherlands this may result in a cost reduction of approximately 1.6 million euro per year. The estimated delay in the detection of recurrent disease would be 3.9, 1.7 and 1.3 months in low, intermediate and high risk NMIBC patients respectively. CONCLUSION: To conclude, the BE can be used to reduce the costs of NMIBC follow-up, with a small delay in diagnosis of recurrent disease. 01 februari 2023

In this paper we presented the mechanical design and evaluation of a low-profile and lightweight exoskeleton that supports the finger extension of stroke patients during daily activities without applying axial forces to the finger. The exoskeleton consists of a flexible structure that is secured to the index finger of the user while the thumb is fixed in an opposed position. Pulling on a cable will extend the flexed index finger joint such that objects can be grasped. The device can achieve a grasp size of at least 7 cm. Technical tests confirmed that the exoskeleton was able to counteract the passive flexion moments corresponding to the index finger of a severely affected stroke patient (with an MCP joint stiffness of k = 0.63Nm/rad), requiring a maximum cable activation force of 58.8N. A feasibility study with stroke patients (n=4) revealed that the body-powered operation of the exoskeleton with the contralateral hand caused a mean increase of 46° in the range of motion of the index finger MCP joint. The patients (n=2) who performed the Box & Block Test were able to grasp and transfer maximally 6 blocks in 60 sec. with exoskeleton, compared to 0 blocks without exoskeleton. Our results showed that the developed exoskeleton has the potential to partially restore hand function of stroke patients with impaired finger extension capabilities. An actuation strategy that does not involve the contralateral hand should be implemented during further development to make the exoskeleton suitable for bimanual daily activities.

Introduction: Emergency medicine (EM) residents take the American Board of Emergency Medicine (ABEM) In-Training Examination (ITE) every year. This examination is based on the ABEM Model of Clinical Practice (Model). The purpose of this study was to determine whether a relationship exists between the number of patient encounters a resident sees within a specific clinical domain and their ITE performance on questions that are related to that domain. Methods: Chief complaint data for each patient encounter was taken from the electronic health record for EM residents graduating in three consecutive years between 2016-2021. We excluded patient encounters without an assigned resident or a listed chief complaint. Chief complaints were then categorized into one of 20 domains based on the 2016 Model. We calculated correlations between the total number of encounters seen by a resident for all clinical years and their ITE performance for the corresponding clinical domain from their third year of training. Results: Available for analysis were a total of 232,625 patient encounters and 69 eligible residents who treated the patients. We found no statistically significant correlations following Bonferroni correction for multiple analyses. Conclusion: There was no correlation between the number of patient encounters a resident has within a clinical domain and their ITE performance on questions corresponding to that domain. This suggests the need for separate but parallel educational missions to achieve success in both the clinical environment and standardized testing.

Arterial stenosis is a high-risk disease accompanied by large amounts of calcified deposits and plaques that develop inside the vasculature. These deposits should be reduced to improve blood flow. However, current methods used to reduce stenosis require externally-controlled actuation systems resulting in limited workspace or patient risks. This results in an unexplored preference regarding the revascularization strategy for symptomatic artery stenosis. In this paper, we propose a novel internally-actuated solution: a magnetic spring-loaded rotablation catheter. The catheter is developed to achieve stenosis-debulking capabilities by actuating drill bits using two internal electromagnetic coils and a magnetic reciprocating spring-loaded shaft. The state-space model of the catheter is validated by comparing the simulation results of the magnetic fields of the internal coils with the experimental results of a fabricated prototype. Contact forces of the catheter tip are measured experimentally, resulting in a maximum axial force of 2.63 N and a torque of 5.69 mN-m. Finally, we present interventions in which the catheter is inserted to a vascular target site and demonstrate plaque-specific treatment using different detachable actuator bits. Calcified deposits are debulked and visualized via ultrasound imaging. The catheter can reduce a stenosis cross-sectional area by up to 35%, indicating the potential for the treatment of calcified lesions, which could prevent restenosis.

BACKGROUND Emergency department (ED) providers are important collaborators in preventing falls for older adults because they are often the first healthcare providers to see a patient after a fall and because at-home falls are often preceded by previous ED visits. Previous work has shown that ED referrals to falls interventions can reduce the risk of an at-home fall by 38%. Screening patients at risk for a fall can be time-consuming and difficult to implement in the ED setting. Machine learning (ML) and clinical decision support (CDS) offer the potential of automating the screening process. However, it remains unclear whether automation of screening and referrals can reduce the risk of future falls among older patients. OBJECTIVE The goal of this paper to is describe a research protocol for evaluating effectiveness of an automated screening and referral intervention. These findings will inform ongoing discussions about the use of machine learning and artificial intelligence to augment medical decision making. METHODS To assess effectiveness of our program for patients receiving the falls risk intervention, our primary analysis will be to obtain referral completion rate at three different EDs. We use a quasi-experimental design known as a sharp regression discontinuity with regards to intent-to-treat, since the intervention is administered to patients whose risk score falls above some threshold. A conditional logistic regression model will be built to describe six-month fall risk at each site as a function of the intervention, patient demographics, and risk score. The odds ratio of return visit for fall and its 95% confidence interval will be estimated comparing those that identified as high risk by the ML-based CDS (ML-CDS) and those who were not but had a similar risk profile. RESULTS The ML-CDS tool under study has been implemented at two of the three EDs in our study. As of April 2023, a total of 1326 patient encounters have been flagged for providers, and 339 unique patients have been referred to the mobility and falls clinic. To date, 45 (15%) patients have scheduled an appointment with the clinic. CONCLUSIONS This study seeks to quantify the impact of an ML-CDS intervention on patient behavior and outcomes. Our end-to-end dataset allows for a more meaningful analysis of patient outcomes than other studies focused on interim outcomes, and our multi-site implementation plan will demonstrate applicability to a broad population and possibility to adapt intervention to other emergency departments and achieve similar results. Our statistical methodology, regression discontinuity design, allows for causal inference from observational data and staggered implementation strategy allows for the identification of secular trends that could affect causal association and mitigate as necessary. CLINICALTRIAL This observational quasi-experiment is registered with clinicaltrials.gov as NCT05810064

Images from a kidney lamella after perfusion made with the clinical laparoscopic fluorescence camera showing normal kidney parenchyma (A): visible light image (B): corresponding fluorescence image.

Biodistribution of Iodine-131-girentuximab-IRDye800CW and the irrelevant control Iodine-125-IgG-IRDye800CW in tumor and normal tissue samples. Left: first control experiment (#6). The mean tumor-to-normal-ratio for girentuximab and the irrelevant control antibody were 6 and 1, respectively. Right: second control experiment (#7). The mean tumor-to-normal-ratio for girentuximab and the irrelevant control antibody were 10 and 1, respectively.

Video made with the laparoscopic fluorescence camera during experiment #1.

Supplementary Materials- figure legends

Overview of the results of perfusion experiment #2. High uptake of dual-labeled girentuximab was observed in two foci (*) of tumor thrombus in the renal vein (A, B). The central region of the tumor largely consists of necrosis, with little and inhomogeneous uptake of dual-labeled girentuximab. Histology confirms that the tumor center consists of fibrosis and necrosis (H&E staining detail, C), without CAIX expression (D).

Purpose: Antibodies labeled with both a near-infrared fluorescent dye and a radionuclide can be used for tumor-targeted intraoperative dual-modality imaging. Girentuximab is a chimeric monoclonal antibody against carbonic anhydrase IX (CAIX), an antigen expressed in 95% of clear cell renal cell carcinoma (ccRCC). This study aimed to assess the feasibility of targeted dual-modality imaging with 111In-girentuximab-IRDye800CW using ex vivo perfusion of human tumorous kidneys.Experimental Design: Seven radical nephrectomy specimens from patients with ccRCC were perfused during 11 to 15 hours with dual-labeled girentuximab and subsequently rinsed during 2.5 to 4 hours with Ringer's Lactate solution. Then, dual-modality imaging was performed on a 5- to 10-mm-thick lamella of the kidney. Fluorescence imaging was performed with a clinical fluorescence camera set-up as applied during image-guided surgery. The distribution of Indium-111 in the slice of tumor tissue was visualized by autoradiography. In two perfusions, an additional dual-labeled control antibody was added to demonstrate specific accumulation of dual-labeled girentuximab in CAIX-expressing tumor tissue.Results: Both radionuclide and fluorescence imaging clearly visualized uptake in tumor tissue and tumor-to-normal tissue borders, as confirmed (immuno)histochemically and by gamma counting. Maximum uptake of girentuximab in tumor tissue was 0.33% of the injected dose per gram (mean, 0.12 %ID/g; range, 0.01–0.33 %ID/g), whereas maximum uptake in the normal kidney tissue was 0.04 %ID/g (mean, 0.02 %ID/g; range, 0.00–0.04 %ID/g).Conclusions: Dual-labeled girentuximab accumulated specifically in ccRCC tissue, indicating the feasibility of dual-modality imaging to detect ccRCC. A clinical study to evaluate intraoperative dual-modality imaging in patients with ccRCC has been initiated. Clin Cancer Res; 22(18); 4634–42. ©2016 AACR.

Tissue section of normal kidney parenchyma showing the absence of CAIX-expression (A) and corresponding absence of a radioactive (B) and fluorescent (C) signal in normal tissue. In the H&E staining detail (D) normal glomeruli are present lacking CAIX-expression (E) as seen in tumor tissue.

Photograph (A) and autoradiographic image (B) of the second control experiment showing high uptake of Iodine-131-girentuximab-IRDye800CW in tumor tissue. The low energy gamma radiation of Iodine-125 is not visible in this autoradiography.

Photograph of an ex vivo tumorous kidney during a perfusion experiment. In this kidney, two renal arteries were connected to the perfusion system. During perfusion, the kidney was kept at 0-4 {degree sign}C and protected from light.

Schematic overview of the different steps of the perfusion experiment.

Across four studies, we examine how public negative labeling, which is when a group member is publicly identified as bad, affects team performance. Across three experiments and one field study, we test and find support for our model, that public negative labeling undermines team performance via reduced perceptions of team interaction quality. Our study contributes to the expansive conversation on team effectiveness which highlights that “fighting fire with fire” in terms of public negative labeling is ineffective for dealing with uncivil workplace behavior.

Background Hepatitis C (HCV) remains a major cause of liver-related morbidity and mortality even though direct-acting antiviral drugs (DAAs) are increasingly accessible and have cure rates approaching 100%. The demographics of HCV have shifted to younger patients, primarily due to the opioid epidemic and associated increased numbers of people who inject drugs (PWID). A robust screening program targeting patients with opioid use disorder (OUD) can identify patients with HCV and present opportunities for linkage to care, cure, and disease prevention by breaking the chain of transmission in high-risk groups. Methods As part of an organizational opioid stewardship long-term goal (2018-2020), Novant Health screened patients with OUD for HCV. A best practice alert (BPA) in the electronic health record (EHR) prompted providers to order HCV antibody. Management of positive tests was left to the discretion of the ordering provider. The disposition of patients with a positive HCV antibody was evaluated by retrospective chart review with patients categorized as: (a) known spontaneous virus clearance (b) linked to care with HCV specialist (c) previous treatment (d) not appropriately linked to care (e) not linked to care due to patient-directed discharge or nonadherence. Results Of 5560 patients encountered (average age 40.9, 49% female, 73.7% White, 21.8% AA/Black), 4405 patients were tested. Of those screened, 33.9% were positive. Among those with a positive HCV antibody, 24% had known spontaneous viral clearance and 73.9% needed linkage to care or follow up bloodwork, with 301 linked to care and 804 not successfully linked. Of eligible patients, 27.2% were linked to care. Conclusion There is a need for ongoing screening efforts in patients with OUD. Despite a BPA intervention, a large percentage of positive patients were not appropriately linked to care. Barriers to linkage include lack of provider education on HCV referral and treatment concurrent to the BPA rollout, as well as psychiatric comorbidities and social vulnerabilities more prevalent in patients with OUD. Disclosures All Authors: No reported disclosures.

Objective Optimal medical therapy for acute lower extremity deep venous thrombosis (DVT) remains an enigma. While clinical trials demonstrate non-inferiority with an oral anti-Xa inhibitor, or direct oral anticoagulant (DOAC), versus combined low–molecular weight heparin (LMWH) and oral vitamin K antagonist (VKA), the most effective regimen remains to be determined. Methods This study is a single-center retrospective cohort study from October 2014 to December 2015 of patients with a diagnosis of acute DVT and subsequent serial lower extremity venous duplex. Demographics, medical history, medications, serial ultrasound findings, as well as the primary anticoagulant used for treatment were collected and analyzed by two independent data extractors. Treatment failure was defined as any new DVT or progression of an existing DVT within 3 months of diagnosis of the index clot. Risk factors for treatment failure were assessed using standard odds ratios and Fischer’s exact test. Results Among 496 patients with an acute lower extremity DVT, 54% ( n = 266) were men, mean age was 61 years, 35% ( n = 174) involved the popliteal or more proximal segments, and 442 had documentation of the primary treatment for DVT: 20% ( n = 90) received nothing; 20% ( n = 92) received an oral VKA; 34% ( n = 149) received a DOAC; 20% ( n = 90) received LMWH; and 5% ( n = 21) received another class of anticoagulant. Within 3 months, 21% ( n=89 out of 427) had treatment failure defined as any new DVT or progression of prior DVT. Patients treated with a DOAC were less likely to experience treatment failure when compared with any other treatment (odds ratio 0.43; 95% confidence intervals [0.23, 0.79]; p = 0.0069) and when compared with traditional oral VKA (OR 0.44; 95% CI [0.21, 0.92]; p = 0.029). None of prior history of DVT, pulmonary embolism, thrombophilia, renal insufficiency, hepatic insufficiency, cancer, or antiplatelet therapy correlated with treatment failure. Treatment outcome did not correlate with being on any anticoagulation versus none ( p = 0.74), nor did it correlate with the duration of treatment (Conclusion In summary, the use of a DOAC for acute lower extremity DVT yielded better overall outcomes and fewer treatment failures at 3 months as compared to traditional oral VKA therapy based on serial duplex imaging.

This review describes the authors' experiences in offering gender-affirming primary care and hormonal care using an evidence-based, interprofessional, and multidisciplinary approach. The authors offer references for best practices set forth by organizations and thought leaders in transgender health and describe the key processes they developed to respectfully deliver affirming care to transgender and nonbinary patients.

Although the prevalence of heart failure with preserved ejection fraction (HFpEF) is increasing, evidence-based therapies for HFpEF remain limited, likely due to an incomplete understanding of this disease. This study sought to identify the cardiac-specific features of protein and phosphoprotein changes in a murine model of HFpEF using mass spectrometry. HFpEF mice demonstrated moderate hypertension, left ventricle (LV) hypertrophy, lung congestion and diastolic dysfunction. Proteomics analysis of the LV tissue showed that 897 proteins were differentially expressed between HFpEF and Sham mice. We observed abundant changes in sarcomeric proteins, mitochondrial-related proteins, and NAD-dependent protein deacetylase sirtuin-3 (SIRT3). Upregulated pathways by GSEA analysis were related to immune modulation and muscle contraction, while downregulated pathways were predominantly related to mitochondrial metabolism. Western blot analysis validated SIRT3 downregulated cardiac expression in HFpEF vs. Sham (0.8 ± 0.0 vs. 1.0 ± 0.0; P < 0.001). Phosphoproteomics analysis showed that 72 phosphosites were differentially regulated between HFpEF and Sham LV. Aberrant phosphorylation patterns mostly occurred in sarcomere proteins and nuclear-localized proteins associated with contractile dysfunction and cardiac hypertrophy. Seven aberrant phosphosites were observed at the z-disk binding region of titin. Additional agarose gel analysis showed that while total titin cardiac expression remained unaltered, its stiffer N2B isoform was significantly increased in HFpEF vs. Sham (0.144 ± 0.01 vs. 0.127 ± 0.01; P < 0.05). In summary, this study demonstrates marked changes in proteins related to mitochondrial metabolism and the cardiac contractile apparatus in HFpEF. We propose that SIRT3 may play a role in perpetuating these changes and may be a target for drug development in HFpEF.

G-Protein Pathway Suppressor 2 (GPS2) is an inhibitor of non-proteolytic K63 ubiquitination mediated by the E2 ubiquitin-conjugating enzyme Ubc13. Previous studies have associated GPS2-mediated restriction of ubiquitination with the regulation of insulin signaling, inflammatory responses and mitochondria-nuclear communication across different tissues and cell types. However, a detailed understanding of the targets of GPS2/Ubc13 activity is lacking. Here, we have dissected the GPS2-regulated K63 ubiquitome in mouse embryonic fibroblasts and human breast cancer cells, unexpectedly finding an enrichment for proteins involved in RNA binding and translation on the outer mitochondrial membrane. Characterization of the RNA-binding protein PABPC1 as a target of GPS2-regulated ubiquitination within the mitochondrial compartment revealed a strategy for regulating the mitochondrial proteome via MUL1-mediated ubiquitination. Removal of GPS2-mediated inhibition, either via genetic deletion or stress-induced nuclear translocation, promotes the mitochondria-associated translation of selected mRNAs leading to increased expression of an adaptive antioxidant program. In light of GPS2 role in nuclear-mitochondria communication, these findings reveal an exquisite regulatory network for modulating mitochondrial gene expression through spatially coordinated transcription and translation.

Analysing how news media portray A.I. reveals what interpretative frameworks around the technology circulate in public discourses. This allows for critical reflections on the making of meaning in prevalent narratives about A.I. and its impact. While research on the public perception of datafication and automation is growing, only a few studies investigate news framing practices. The present study connects to this nascent research area by charting A.I. news frames in four internationally renowned media outlets: The New York Times, The Guardian, Wired, and Gizmodo. The main goals are to identify dominant emphasis frames in AI news reporting over the past decade, to explore whether certain A.I. frames are associated with specific data risks (surveillance, data bias, cyber-war/cyber-crime, and information disorder), and what journalists and experts contribute to the media discourse. An automated content analysis serves for inductive frame detection (N = 3098), identification of risk references (dictionary-based), and network analysis of news writers. The results show how A.I.’s ubiquity emerged rapidly in the mid-2010s, and that the news discourse became more critical over time. It is further argued that A.I. news reporting is an important factor in building critical data literacy among lay audiences.

Growing evidence supports acupuncture for several pain conditions including chronic prostatitis. This study aimed to determine the safety, tolerability, and effectiveness of acupuncture in reducing pain in women with interstitial cystitis/bladder pain syndrome (IC/BPS).This prospective randomized single-blinded study compared electro-acupuncture (EA) to minimal acupuncture (MA) after 6 weekly treatments and again after 6 weeks of no treatment. Pain was assessed using the Brief Pain Inventory-Short Form (worst pain, average pain, pain severity, pain interference) and the Pain Catastrophizing Scale (PCS). Physical exams evaluated pelvic floor muscle tenderness. Mixed-effects models were used to estimate adjusted means over follow up.Patients were randomized to EA (n = 11) or MA (n = 10). There were no adverse events. Both groups' worst pain improved at 6 weeks, -2.91 ± 0.59 and -2.09 ± 0.68 for EA and MA respectively with no difference between groups (p = 0.37). Results were similar at 12 weeks. The EA group had greater improvement in pain interference at 6 weeks, -3.28 ± 0.51 versus -1.67 ± 0.58 (p = 0.049). The between group difference was not maintained at 12 weeks (p = 0.13). Average pain and pain severity showed no difference between groups (p0.05). The PCS improved overall at 6 weeks, -6.2 ± 2.5 (p = 0.03), with no difference between groups (p = 0.39). On physical exam, only the EA group showed a significant decrease in levator ani tenderness (p = 0.031) after treatment.Both EA and MA showed improvement in worst pain scores, however EA showed greater improvement in pain interference and pelvic floor muscle tenderness in women with IC/BPS.

Oil palm production in Indonesia illustrates the intense pressure that exists worldwide to convert natural ecosystems to agricultural production. Oil palm production has increased because of expansion of cultivated area rather than due to average-yield increases. We used a data-rich modelling approach to investigate how intensification on existing plantations could help Indonesia meet palm oil demand while preserving fragile ecosystems. We found that average current yield represents 62% and 53% of the attainable yield in large and smallholder plantations, respectively. Narrowing yield gaps via improved agronomic management, together with a limited expansion that excludes fragile ecosystems, would save 2.6 million hectares of forests and peatlands and avoid 732 MtCO2e compared with following historical trends in yield and land use. Fine-tuning policy to promote intensification, along with investments in agricultural research and development, can help reconcile economic and environmental goals. Oil palm production in Indonesia has expanded by converting more natural ecosystems to agricultural ones. This study finds large yield gaps among large and smallholder farms there, suggesting improved management could increase production while sparing fragile ecosystems.

Recent meta-analytic studies imply that groups often find ways of neutralizing turnover’s harmful effects and that important moderators of the turnover–performance relationship must be missing from the literature. Building on theory and findings related to the threat–rigidity effect, we suggest that groups tend to respond maladaptively to turnover when group norms promote the idea that turnover is threatening. Specifically, we suggest that prevention climate—that is, a climate focused on minimizing mistakes and costs—largely determines the degree to which group norms encourage members to view turnover as threatening and, in turn, the degree to which groups become less adaptive and perform worse in response to turnover. Across a sample of 232 groups, we found evidence that turnover is indeed more negatively related to performance for those groups with a strong prevention climate. Further, in a controlled laboratory context where we manipulated turnover and prevention climate, we found causal evidence supporting our full conceptual model. Our work advances research on turnover by identifying an important moderator and an underlying mechanism of the turnover–performance relationship.

INTRODUCTION: Before the 1800s, dogs were probably primarily selected for functional roles such as hunting, guarding, and herding. Modern dog breeds are a recent invention defined by conformation to a physical ideal and purity of lineage. Breeds are commonly ascribed temperaments and behavioral proclivities based on the purported function of the ancestral source population. By extension, the breed ancestry of individual dogs is assumed to be predictive of temperament and behavior. Through our community science project Darwin’s Ark (darwinsark.org), we enrolled a diverse cohort of pet dogs to explore how genetics shapes complex behavioral traits in this exceptional natural model. RATIONALE: Dogs are a natural system for investigating the genetics of complex traits. Millions of pet dogs live in human homes, sharing our environment, and receive sophisticated medical care. Behavioral disorders are treated with human psychiatric drugs, achieving similar response rates, and genetic studies suggest shared etiology with some human psychiatric conditions. We developed Darwin’s Ark as an open data resource for collecting owner-reported phenotypes and genetic data and invited any dog owner to enroll their dog. We paired this with low-pass sequencing to capture nearly all common variation in this outbred population. Our inclusive approach achieved the large samples needed to investigate complex traits. RESULTS: We surveyed owners of 18,385 dogs (49% purebred) and sequenced the DNA of 2155 dogs. Most behavioral traits are heritable [heritability (h(2)) > 25%], but behavior only subtly differentiates breeds. Breed offers little predictive value for individuals, explaining just 9% of variation in behavior. For more heritable, more breed-differentiated traits, like biddability (responsiveness to direction and commands), knowing breed ancestry can make behavioral predictions somewhat more accurate (see the figure). For less heritable, less breed-differentiated traits, like agonistic threshold (how easily a dog is provoked by frightening or uncomfortable stimuli), breed is almost uninformative. We used dogs of mixed breed ancestry to test the genetic effect of breed ancestry on behavior and compared that to survey responses from purebred dog owners. For some traits, like biddability and border collie ancestry, we confirm a genetic effect of breed that aligns with survey responses. For others, like human sociability and Labrador retriever ancestry, we found no significant effect. Through genome-wide association, we found 11 regions that are significantly associated with behavior, including howling frequency and human sociability, and 136 suggestive regions. Regions associated with aesthetic traits are unusually differentiated in breeds, consistent with a history of selection, but those associated with behavior are not. CONCLUSION: In our ancestrally diverse cohort, we show that behavioral characteristics ascribed to modern breeds are polygenic, environmentally influenced, and found, at varying prevalence, in all breeds. We propose that behaviors perceived as characteristic of modern breeds derive from thousands of years of polygenic adaptation that predates breed formation, with modern breeds distinguished primarily by aesthetic traits. By embracing the full diversity of dogs—including purebred dogs, mixed-breed dogs, purpose-bred working dogs, and village dogs—we can fully realize dogs’ long-recognized potential as a natural model for genetic discovery.

The user experience of our daily interactions is increasingly shaped with the aid of AI, mostly as the output of recommendation engines. However, it is less common to present users with possibilities to navigate or adapt such output. In this paper we argue that adding such algorithmic controls can be a potent strategy to create explainable AI and to aid users in building adequate mental models of the system. We describe our efforts to create a pattern library for algorithmic controls: the algorithmic affordances pattern library. The library can aid in bridging research efforts to explore and evaluate algorithmic controls and emerging practices in commercial applications, therewith scaffolding a more evidence-based adoption of algorithmic controls in industry. A first version of the library suggested four distinct categories of algorithmic controls: feeding the algorithm, tuning algorithmic parameters, activating recommendation contexts, and navigating the recommendation space. In this paper we discuss these and reflect on how each of them could aid explainability. Based on this reflection, we unfold a sketch for a future research agenda. The paper also serves as an open invitation to the XAI community to strengthen our approach with things we missed so far.

Evaluate the impact of positive oral contrast material (POCM) for non-traumatic abdominal pain on diagnostic confidence, diagnostic rate, and ED throughput.ED oral contrast guidelines were changed to limit use of POCM. A total of 2,690 abdominopelvic CT exams performed for non-traumatic abdominal pain were prospectively evaluated for diagnostic confidence (5-point scale at 20% increments; 5 = 80-100% confidence) during a 24-month period. Impact on ED metrics including time from CT order to exam, preliminary read, ED length of stay (LOS), and repeat CT scan within 7 days was assessed. A subset of cases (n = 729) was evaluated for diagnostic rate. Data were collected at 2 time points, 6 and 24 months following the change.A total of 38 reviewers were participated (28 trainees, 10 staff). 1238 exams (46%) were done with POCM, 1452 (54%) were performed without POCM. For examinations with POCM, 80% of exams received a diagnostic confidence score of 5 (mean, 4.78 ± 0.43; 99% ≥ 4), whereas 60% of exams without POCM received a score of 5 (mean, 4.51 ± 0.70; 92% ≥ 4; p .001). Trainees scored 1,523 exams (57%, 722 + POCM, 801 -POCM) and showed even lower diagnostic confidence in cases without PCOM compared with faculty (mean, 4.43 ± 0.68 vs. 4.59 ± 0.71; p 0.001). Diagnostic rate in a randomly selected subset of exams (n = 729) was 54.2% in the POCM group versus 56.1% without POCM (p 0.655). CT order to exam time decreased by 31 min, order to preliminary read decreased by 33 min, and ED LOS decreased by 30 min (approximately 8% of total LOS) in the group without POCM compared to those with POCM (p 0.001 for all). 205 patients had a repeat scan within 7 days, 74 (36%) had IV contrast only, 131 (64%) had both IV and oral contrast on initial exam. Findings were consistent both over a 6-month evaluation period as well as the full 24-month study period.Limiting use of POCM in the ED for non-traumatic abdominal pain improved ED throughput but impaired diagnostic confidence, particularly in trainees; however, it did not significantly impact diagnostic rates nor proportion of repeat CT exams.

In this letter we demonstrate a pneumatic bending actuator for upper-limb assistive wearable robots which uses thin McKibben muscles in combination with a flexure strip. The actuator features both active soft actuation and passive gravity support, and in terms of force transmission bridges the gap between the classic rigid type actuators and the emerging soft actuator technologies. Its flexure strip leverages the high-force low-displacement properties of McKibben muscles towards a large rotational range of motion and reduces localized forces at the attachments. We explain the synthesis method by which these actuators can be obtained and optimized for high specific moment output. Physical specimens of three optimized actuator designs are built and tested on a dedicated experimental setup, verifying the computational models. Furthermore, a proof-of-concept upper-limb assistive wearable robot is presented to illustrate a practical application of this actuator and its potential for close-to-body alignment. We found that based on our currently available components actuators can be built which, given a width of 80 mm, are able to produce a moment exceeding 4 Nm at an arm elevation of 90 deg.

Supplemental material, sj-docx-1-sgr-10.1177_10464964221082516 for Public Negative Labeling Effects on Team Interaction and Performance by Jessica F. Kirk, David R. Hekman, Elsa T. Chan and Maw-Der Foo in Small Group Research

Supplemental material, sj-docx-1-sgr-10.1177_10464964221082516 for Public Negative Labeling Effects on Team Interaction and Performance by Jessica F. Kirk, David R. Hekman, Elsa T. Chan and Maw-Der Foo in Small Group Research

Sonographers performing venous duplex ultrasound (VDUS) of patients with coronavirus disease 2019 (COVID-19) have an increased risk of exposure owing to their close contact with these patients for an extended period. The objective of the present study was to evaluate the efficacy of a modified COVID-19 VDUS protocol to reduce sonographer exposure to COVID-19 patients.We performed a single-center retrospective review. Patients who had undergone VDUS under the modified COVID-19 protocol between March 1, 2020, and June 30, 2020, with a confirmed or presumed COVID-19 diagnosis at the VDUS were included. The modified COVID-19 protocol was defined as the ability of the sonographer to terminate the examination on detection of an acute deep vein thrombosis (DVT). The primary outcome measures were the number of anatomic deep venous segments recorded by the sonographer, which was used as a surrogate measure for sonographer exposure time, and the number of acute DVTs found on follow-up examinations in segments not visualized at the index VDUS.A total of 160 lower extremity VDUS (LEVDUS) scans and 72 upper extremity VDUS (UEVDUS) scans were performed using the modified COVID-19 protocol. The index VDUS had found an acute DVT for 44 of 160 patients (27.5%) who had undergone LEVDUS and 26 of 72 (36.6%) who had undergone UEVDUS. On follow-up imaging, 7 of 38 LEVDUS scans (17.9%) and 1 of 10 UEVDUS scans (10%) had demonstrated a new acute DVT. Malignancy and surgery 30 days before imaging were significantly associated with acute lower extremity DVT, and mechanical ventilation and extracorporeal membrane oxygenation were associated with acute upper extremity DVT. On the index VDUS, the average was 10.6 of 12 total visualized segments on LEVDUS and 6.4 of 10 total segments on UEVDUS. Of the index VDUS scans, 35.6% of the LEVDUS and 78.6% of the UEVDUS scans had been abbreviated. The index VDUS scans that were positive for acute DVT had had significantly fewer visualized segments for both lower (8.4 vs 11.5; P .0001) and upper (4.2 vs 7.6) extremities (P .0001). On the follow-up examinations, only one of eight new acute DVTs had been found in a patient whose index VDUS had been abbreviated and the corresponding segment not assessed. These findings did not affect the patient's clinical course.The modified COVID-19 VDUS protocol reduced sonographers' potential exposure time to COVID-19. Additionally, the clinical efficacy was maintained, with no missed DVTs, despite the abbreviation of the VDUS examinations.

Background Surgical training is constantly adapting to better prepare trainees for an evolving landscape of surgical practice. Training in vascular surgery additionally underwent a paradigm shift with the introduction of the integrated training pathway now more than a decade ago. With this study, we sought to characterize the needs and goals of our current vascular surgery trainee population. Methods The Association of Program Directors in Vascular Surgery Issues Committee compiled a survey to assess demographics, current needs, and goals of trainees and to evaluate trainee distress using a validated seven-item Physician Well-Being Index. The survey was distributed electronically to all current vascular surgery trainees and recent graduates in the academic years 2016-2017 and 2017-2018, and responses were recorded anonymously. Results During the 2 years of the survey, the response rate was 30% (n = 367/1196). The respondents were 55% (n = 202) integrated vascular residents and 45% (n = 165) vascular surgery fellows. In each year of the survey, 60% (n = 102/170) and 58% (n = 86/148) of trainees expressed a desire to pursue academics in their careers, whereas 37% (n = 63/174) and 35% (n = 53/152) indicated their program had structured academic development time (2016-2017 and 2017-2018, respectively). Fifty-five percent (n = 96/174) and 52% (n = 79/152) stated that the overall impact of collaborative learners was positive. More than 60% of respondents in both years of the survey indicated experiencing one or more symptoms of distress on a weekly basis. The frequency of distress was associated with older age and with the presence of an advanced degree in both years of the survey. Sex, level of training, presence of collaborative learners, and having protected research time were not associated with frequency of distress in either year of the survey. Conclusions These results highlight an opportunity for programs to further evaluate the needs of their trainees for academic development during vascular surgery training to better accommodate trainees' career goals. Further investigation to identify modifiable risk factors for distress among vascular surgery trainees is warranted.

Since 2018, the Centers for MedicareMedicaid Services (CMS) guidelines have allowed teaching physicians to bill for evaluation and management services based on medical student documentation. Limited previous data suggest that medical student documentation suffers from a high rate of downcoding relative to faculty documentation. We sought to compare the coding outcomes of documentation performed by medical students, and not edited by faculty, with documentation edited and submitted by faculty.A total of 104 randomly selected notes from real patient encounters written by senior medical students were compared to the revised notes submitted by faculty. The note pairs were then split and reviewed by blinded professional coders and assigned level of service (LoS) codes 1-5 (corresponding to EM CPT codes 99281-99285).We found that the LoS agreement between student and faculty note versions was 63%, with 23% of all student notes receiving lower LoS compared to faculty notes (downcoded). This was found to be similar to baseline variability in professional coder LoS designations.Notes from medical students who have completed a focused documentation curriculum have less LoS downcoding than in previous reports.

The effect of age dependent pharmacokinetics (PK) on the clinical efficacy of oxytetracycline (OTC) against Bovine Respiratory Disease (BRD) in beef cattle was studied, using a Physiologically Based Pharmacokinetic (PBPK) model. The model includes a bodyweight dependent renal clearance. To mimic/reproduce the long terminal half-live a bone forming tissue compartment was considered. Data for the development, calibration and validation of the model were obtained from public literature. To integrate the PK with the pharmacodynamics (PD) of OTC, Monte Carlo simulations were performed using this PBPK model to predict time-concentration curves for two commonly used dosing regimens of short-acting and long-acting injectable OTC formulations in virtual populations of 5,000 steer calves of 100 kg and 400 kg. These curves were then used to calculate the value of the PKPD index for OTC, which is the ratio of the area under the concentration-time curve for 24 h (AUC24h) over the minimum inhibitory concentration (MIC) of the target pathogen (AUC24h/MIC). The MIC values were for Mannheimia haemolytica, the dose-limiting pathogen for BRD. This integration of PBPK and PD for OTC used for the treatment of BRD in calves indicated that the Probability of Target Attainment (PTA) was sufficient for efficacy in calves of 400 kg, but insufficient for calves of 100 kg, when using a long acting dosing regimen of 20 mg/kg BW, twice, with a 48-h interval. The use of a dosing regimen of 10 mg/kg BW/day for 4 days predicted sufficient PTAs in both age groups.

In a typical vibrations course, students learn mathematical models to predict the response of vibratory systems. Often, students have trouble visualizing what they are calculating with the equations. The goal is to have a visual example of the motions that are represented in the equations. Because of in-person meeting restrictions, demonstration experiments were recorded before class time, which allowed the analysis to be completed before class. A Pasco smart cart system was used to create the demonstrations. The carts are connected to the computer via Bluetooth and can measure force, position, and acceleration. Using the force sensor, the spring constant and magnetic damping coefficient are determined. Demonstrations were created for one and two degree of freedom systems. The response was shown for systems with and without magnetic damping. Free and forced responses were measured in all the cases. For single degree of freedom systems, higher-order components of the input were explored and using the convolution integral to calculate the response. At the end of the semester, students took a survey to learn of their experience. Overall, students strongly appreciated the visual representation of the modeling equations.

Stem cells are enabling an improved understanding of the peripheral arterial disease, and patient-specific stem cell-derived endothelial cells (ECs) present major advantages as a therapeutic modality. However, applications of patient-specific induced pluripotent stem cell (iPSC)-derived ECs are limited by rapid loss of mature cellular function in culture. We hypothesized that changes in autophagy impact the phenotype and cellular proliferation of iPSC-ECs. Endothelial cells were differentiated from distinct induced pluripotent stem cell lines in 2D culture and purified for CD144 positive cells. Autophagy, mitochondrial morphology, and proliferation were characterized during differentiation and over serial passages in culture. We found that autophagy activity was stimulated during differentiation but stagnated in mature iPSC-ECs. Mitochondria remodeled through mitophagy during differentiation and demonstrated increasing membrane potential and mass through serial passages; however, these plateaued, coinciding with decreased proliferation. To evaluate for oxidative damage, iPSC-ECs were alternatively grown under hypoxic culture conditions; however, hypoxia only transiently improved the proliferation. Stimulating mTOR-independent ULK1-mediated autophagy with a plant derivative AMP kinase activator Rg2 significantly improved proliferative capacity of iPSC-ECs over multiple passages. Therefore, autophagy, a known mediator of longevity, played an active role in remodeling mitochondria during maturation from pluripotency to a terminally differentiated state. Autophagy failed to compensate for increasing mitochondrial mass over serial passages, which correlated with loss of proliferation in iPSC-ECs. Stimulating ULK1-kinase-driven autophagy conferred improved proliferation and longevity over multiple passages in culture. This represents a novel approach to overcoming a major barrier limiting the use of iPSC-ECs for clinical and research applications.