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Foundation models are transforming artificial intelligence (AI) in healthcare by providing modular components adaptable for various downstream tasks, making AI development more scalable and cost-effective. Foundation models for structured electronic health records (EHR), trained on coded medical records from millions of patients, demonstrated benefits including increased performance with fewer training labels, and improved robustness to distribution shifts. However, questions remain on the feasibility of sharing these models across hospitals and their performance in local tasks. This multi-center study examined the adaptability of a publicly accessible structured EHR foundation model (FMSM), trained on 2.57 M patient records from Stanford Medicine. Experiments used EHR data from The Hospital for Sick Children (SickKids) and Medical Information Mart for Intensive Care (MIMIC-IV). We assessed both adaptability via continued pretraining on local data, and task adaptability compared to baselines of locally training models from scratch, including a local foundation model. Evaluations on 8 clinical prediction tasks showed that adapting the off-the-shelf FMSM matched the performance of gradient boosting machines (GBM) locally trained on all data while providing a 13% improvement in settings with few task-specific training labels. Continued pretraining on local data showed FMSM required fewer than 1% of training examples to match the fully trained GBM's performance, and was 60 to 90% more sample-efficient than training local foundation models from scratch. Our findings demonstrate that adapting EHR foundation models across hospitals provides improved prediction performance at less cost, underscoring the utility of base foundation models as modular components to streamline the development of healthcare AI. [ABSTRACT FROM AUTHOR]

This study explored two different ways for K‐12 school teachers to access educational makerspace through virtual fieldtrips. K‐12 school teachers from rural areas of the Southeast USA were divided into two groups. The experimental group (n = 48) drove telepresence robots to take their fieldtrip, while the comparison group (n = 23) watched the same fieldtrip through a recorded video. Analyses of the quantitative and qualitative data, collected through surveys and written reflections, showed that the experimental group reported significantly higher scores in embodiment, social presence and engagement (ie, behaviour, emotion and cognition) than the comparison group, and that actual driving the robots for the virtual fieldtrips was highlighted as a favored experience. Educational significance and implications are discussed. Practitioner notesWhat is currently known about this topic With makerspaces gaining increasing attention in K‐12 education, professional development (PD) opportunities are needed to help teachers understand makerspaces and related technologies.Teachers in rural areas are faced with the challenges of accessing makerspace resources and opportunities, especially during the COVID‐19 pandemic.Little research has explored teacher makerspace PD in rural areas.Maker resource deficiency in rural areas and the COVID‐19 pandemic call for an alternative approach to the makerspace PD, particularly for teachers in rural areas.What this paper adds Explored the use of telepresence robots for rural teachers to access an authentic makerspace through virtual fieldtrips.Examined the effects of virtual fieldtrip to access makerspaces on K‐12 teachers' embodiment, social presence and engagement.Examined the aspects of the telepresence fieldtrip that were most valuable to K‐12 teachers.Investigated the factors that contribute to teachers' engagement in a virtual fieldtrip.Implications for practitioners Telepresence robot was an effective tool that enabled teachers in rural areas to explore authentic makerspaces through a virtual trip over distance.To help teachers conceptualize the idea of makerspace, it is important to allow teachers to move in the physical makerspace and interact with the environment.To design an engaging fieldtrip that triggers active learning, more attention should be given to how to develop the emotional aspect of a fieldtrip experience.Embodiment plays an important role in virtual fieldtrips. When teachers have a higher level of embodiment, they are more likely to be emotionally and cognitively engaged in a fieldtrip experience. [ABSTRACT FROM AUTHOR]

Presents a study which aimed to elicit the subjective responses of caregivers of stroke survivors regarding caregiving in the U.S. Role of nurses in promoting effective caregiving to stroke survivors; Impact of caregiving on the caregiver; Actions that should be taken by nurses and other health care team to achieve quality care for stroke survivors.

Examines the differences among patients with different insurance coverage with respect to their age, severity, level of care, length of stay, and outcome prior to the implementation of the Balanced Budget Act (BBA) in the United States. Use of acute and subacute services by hospitalized stroke patients; Effects of the BBA on patient's use of stroke-related services.

Although some tumor lysis syndrome (TLS) cases have been reported with patients with multiple myeloma (MM) taking monoclonal antibodies (mAbs), the association between TLS and mAbs remains mostly unknown. We aim to investigate the association between TLS and mAbs and describe clinical features. We conducted a disproportionality analysis to investigate the link between mAbs and TLS by excluding known confounders and compared with other anticancer drugs. The association between mAbs and TLS was evaluated using information component (IC). Drug-drug interaction signals were calculated based on the Ω shrinkage measure. Parametric distribution with the goodness-of-fit test was used for the reported time-to-onset analysis. From 2016 Q1, to 2022 Q4, a total of 274 TLS with mAbs were reported in the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. There were 27% of patients with TLS with mAbs who died and 20.1% occurred a life-threatening situation. Daratumumab, elotuzumab, and belantamab mafodotin presented a robust disproportionate signal of TLS after excluding known confounders (IC 025  > 0). Daratumumab had the highest disproportionate signal of TLS among all anticancer drugs for MM. Reported time-to-onset analysis showed the median days for TLS with daratumumab, isatuximab, elotuzumab, and belantamab mafodotin were 1.5, 14.5, 5.5, and 5.5 days, respectively. The drug-drug interaction analysis showed the co-administration of drugs known to increase urate, induce hyperkalemia, or hypocalcemia elevated the reporting frequency for TLS with mAbs (Ω 025  > 0). Our postmarketing pharmacovigilance analysis detected the reporting association of TLS and mAbs in patients with MM. Additional studies with robust epidemiological study designs that can validate these findings are warranted., (© 2023 The Authors. Clinical Pharmacology & Therapeutics © 2023 American Society for Clinical Pharmacology and Therapeutics.)

This paper examines the effects of the COVID-19 pandemic (measured by total cases and deaths per 100K people) on the early-stage entrepreneurship activity (measured by the Kauffman Early-Stage Entrepreneurship indicators) in the United States. The empirical analyses are based on the panel dataset of 51 States between 2020 and 2021. The findings show that the COVID-19 pandemic negatively affects early-stage entrepreneurship activity. Further analyses indicate the positive impact of the COVID-19 pandemic on the startup's early survival rate. However, new entrepreneurs' rate and opportunity share are negatively affected by the COVID-19 pandemic. Implications for the post-COVID-19 era are also discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kang, Guo, Lu and Zhu.)

With the intensification of climate change and human activities, megafires frequently occur, with serious impacts on ecosystems, atmospheric environment, and human health. The United States has accumulated a large amount of practical experience in forest fire management. A comprehensive review of the framework of forest fire management in the United States can provide an inspiring reference for forest fire prevention in China. Starting from the process of historical evolution of forest fire policy, we systematically introduced the four stages of policy evolution and the characteristics of each stage in the US. Moreover, a comprehensive analysis of forest fire management situation in the US from four aspects was conducted, including the management of combustible fuels, administrative responsibility, fire suppression and forest fire management research support. We summarized relevant literature and proposed improvement strategies for future combustibles management, policy politics and fire fighting in the United States. Through the comprehensive analysis of forest fire management in the United States, we put forward some inspiring opinions on forest fire management in China to promote the establishment of a sound forest fire management system with Chinese characteristics.

Despite the increase in number and importance of healthcare ethics committees (HECs), little is known about how successful HECs are and what characteristics contribute to their success. The current study attempted: (1) to examine the effect of respondent backgrounds on the self-reported success and characteristics of HECs, (2) to describe the current success status of HECs, and (3) to explore how committee characteristics are related with the success. Questionnaires on characteristics of respondents and committees as well as the rating of success were distributed to 962 acute care hospitals with 300 beds or more across the United States in the calendar year 2000. A total number of 294 chairpersons and 223 members from 334 ethics committees responded to the survey, yielding a 35% response rate. Statistical analyses on the survey data found that the length of services on committees (seniority) and the size of committees were significant contributors to the perceived success of committees. The significant association of seniority suggests that future studies should control for the effect of seniority, possibly using multivariate modeling methods. The more success perceived by large committees indicates a need for small committees to increase the size of their committees so that they can expand their expertise to resolve the wide variety of current issues.