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Abstract Background Cognitive load impacts performance of debriefers and learners during simulations, but limited data exists examining debriefer cognitive load. The aim of this study is to compare the cognitive load of the debriefers during simulation-based team training (SbTT) with Rapid Cycle Deliberate Practice (RCDP) debriefing and Traditional Reflective Debriefing (TRD). We hypothesize that cognitive load will be reduced during RCDP compared to TRD. Methods This study was part of a large-scale, interdisciplinary team training program at Children’s Healthcare of Atlanta Egleston Pediatric Emergency Department, with 164 learners (physicians, nurses, medical technicians, paramedics, and respiratory therapists (RTs)). Eight debriefers (main facilitators and discipline-specific coaches) led 28 workshops, which were quasi-randomized to either RCDP or TRD. Each session began with a baseline medical resuscitation scenario and cognitive load measurement using the NASA Task Load Index (TLX), and the NASA TLX was repeated immediately following either TRD or RCDP debriefing. Raw scores of the NASA TLX before and after intervention were compared. ANOVA tests were used to compare differences in NASA TLX scores before and after intervention between the RCDP and TRD groups. Results For all debriefers, mean NASA TLX scores for physical demands and frustration significantly decreased (− 0.8, p = 0.004 and − 1.3, p = 0.002) in TRD and mean perceived performance success significantly increased (+ 2.4, p

To fight climate change, it is crucial to have a precise knowledge of greenhouse gas (GHG) concentrations in the atmosphere and to monitor sources and sinks of GHGs. On global scales, satellites are an appropriate monitoring tool. For the validation of the satellite measurements and to tie them to the World Meteorological Organization (WMO) trace gas scale, ground-based Fourier transform infrared (FTIR) networks are used, which provide reference data. To ensure the highest-quality validation data, the network must be scaled to the WMO trace gas scale and have a very small site-to-site bias. Currently, the Total Carbon Column Observing Network (TCCON) is the de facto standard FTIR network for providing reference data. Ensuring a small site-to-site bias is a major challenge for the TCCON. In this work, we describe the development and application of a new method to evaluate the site-to-site bias by using a remotely controlled portable FTIR spectrometer as a travel standard (TS) for evaluating the consistency of columnar GHG measurements performed at different TCCON stations, and we describe campaign results for the TCCON sites in Tsukuba (Japan), East Trout Lake (Canada) and Wollongong (Australia). The TS is based on a characterized portable EM27/SUN FTIR spectrometer equipped with an accurate pressure sensor which is operated in an automated enclosure. The EM27/SUN is the standard instrument of the Collaborative Carbon Column Observing Network (COCCON). The COCCON is designed such that all spectrometers are referenced to a common reference unit located in Karlsruhe, Germany. To evaluate the long-term stability of the TS instrument, it is placed side-by-side with the TCCON instrument in Karlsruhe (KA) and the COCCON reference unit (the EM27/SUN spectrometer SN37, which is operated permanently next to the TCCON-KA site) between deployments to collect comparing measurements. At each of the visited TCCON sites, the TCCON spectrometers collected low-resolution (LR) (0.5 cm−1) and high-resolution (HR) (0.02 cm−1) measurements in an alternating manner. Based on the TS as a portable standard, the measurements are compared to the Karlsruhe site as a common reference. For Tsukuba and Wollongong, the agreement with the reference in Karlsruhe found for XCO2 is on the 0.1 % level for both the LR and HR measurements. For XCH4, the agreement is at the 0.2 % level, with the low-resolution measurements showing a low bias at both sites and for both gases. For XCO, the deviations are up to 7 %. The reason for this is likely to be a known issue with the CO a priori profiles used by the TCCON over source regions. In East Trout Lake (ETL), the TCCON spectrometer broke down while the TS was en route to the station. Hence, no side-by-side comparison was possible there. An important auxiliary value for FTIR retrievals is the surface pressure. Using the pressure sensor in the TS, the surface pressure measurements at each site are also compared. The surface pressure analysis reveals excellent agreement (0.027, 0.135 and 0.094 hPa) for the Tsukuba, ETL and Wollongong sites.

Abstract Background Surgical patients are at risk of postoperative complications, which may lead to increased morbidity, mortality, hospital length-of-stay and healthcare costs. Enhanced Recovery After Surgery (ERAS®) protocols are evidence-based and have demonstrated effectiveness in decreasing complications and associated consequences. However, their adoption in Australia has been limited and the reason for this is unclear. This study aimed to describe clinicians’ perceptions of ERAS protocols in Australia. Methods A national online survey of anaesthetists, surgeons and nurses was undertaken. Invitations to participate were distributed via emails from professional colleges. The 30-item survey captured respondent characteristics, ERAS perceptions, beliefs, education and learning preferences and future planning considerations. The final question was open-ended for elaboration of perceptions of ERAS. Descriptive and inferential statistics were used to describe and compare group differences across disciplines relative to perceptions of ERAS. Results The sample included 178 responses (116 nurses, 65.2%; 36 surgeons, 20.2%; 26 anaesthetists, 14.6%) across six states and two territories. More than half (n = 104; 58.8%) had used ERAS protocols in patient care, and most perceived they were ‘very knowledgeable’ (n = 24; 13.6%) or ‘knowledgeable’ (n = 71; 40.3%) of ERAS. However, fewer nurses had cared for a patient using ERAS (p

In Latin America, rabies virus has persisted in a cycle between Desmodus rotundus vampire bats and cattle, potentially enhanced by deforestation. We modeled bovine rabies virus outbreaks in Costa Rica relative to land-use indicators and found spatial-temporal relationships among rabies virus outbreaks with deforestation as a predictor.

We compared short stories by autistic (n = 19) and non-autistic (n = 23) university students. We used automated software and content analysis to code students' stories. We found that writings were more similar than different. However, autistic students' stories were rated at a higher reading level (p = 0.013) than non-autistic students'. Autistic students' stories contained fewer grammatical errors (p = 0.02) but were less likely to include a climax (p = 0.026). Autistic students reported more positive writing affect than non-autistic students (p = 0.026). Higher writing affect was associated with writing highly fictional texts (p = 0.03) that contained more sentences (p = 0.005). Findings suggest writing may be a strength for autistic students and opportunities to write creatively may promote positive affect toward writing.

What would it be like to learn to live in and experience a world of sentient beings rather than inert objects? How can we learn to awarely participate in a world of communication and interaction, in which trees, crows and rivers may grace us with a response to our attention and our call? How do we learn not just to know this intellectually but 'proved upon our pulses', as John Keats put it. As artist and writer, we reflect on the contribution our practices can have to the ecological crisis of our times, drawing on living cosmos panpsychism and examples from our practice.

Well-designed computer or app-based instruction has a number of potential benefits (eg increasing accessibility and feasibility of high-quality instruction, reducing time and resources required for training expert delivery, saving instructional time). However, variation in implementation can still affect outcomes when using educational technology. Research generally suggests that without follow-up support after training, implementation of educational interventions is often poor and outcomes reduced. However, the extent to which this is the case when the core element of an intervention is computer or app-delivered is not yet clear. This study investigated the effects of providing ongoing implementation support for Headsprout Early Reading (HER, an early reading programme accessible via a computer or an app), to determine whether such support leads to better outcomes. Twenty-two primary schools (269 learners) participated in a cluster-randomised controlled trial. Eleven schools received initial training followed by ongoing support across the school year, whereas the other 11 schools received initial training and technical support only. Pre- and post-measures of reading skills were conducted using the York Assessment of Reading for Comprehension. We found no effect of implementation support on outcomes, and no effect of implementation support on delivery of the core element of HER. However, there were some effects of implementation support on the implementation of other HER elements relating to the responsiveness of educators to learners' learning within HER. These findings have implications for providing access to high quality online instruction in early reading skills at scale, with minimal training. More broadly, the current study suggests that well-designed computer or app-based instruction can yield positive outcomes with minimal implementation support and training. However, further research is required to ensure the interplay between learners' app-based learning and teacher intervention functions as intended to provide additional support for those who need it.

Introduction Chronic kidney disease (CKD) is a heterogeneous group of conditions affecting over 10% of the population, causing substantial morbidity and mortality (1-3). Genetic kidney disorders are well-recognized causes of [...], BACKGROUND. It is unknown whether the risk of kidney disease progression and failure differs between patients with and without genetic kidney disorders. METHODS. Three cohorts were evaluated: the prospective Cure Glomerulonephropathy Network (CureGN) and 2 retrospective cohorts from Columbia University, including 5,727 adults and children with kidney disease from any etiology who underwent whole-genome or exome sequencing. The effects of monogenic kidney disorders and APOL1 kidney-risk genotypes on the risk of kidney failure, estimated glomerular filtration rate (eGFR) decline, and disease remission rates were evaluated along with diagnostic yields and the impact of American College of Medical Genetics secondary findings (ACMG SFs). RESULTS. Monogenic kidney disorders were identified in 371 patients (6.5%), high-risk APOL1 genotypes in 318 (5.5%), and ACMG SFs in 100 (5.2%). Family history of kidney disease was the strongest predictor of monogenic disorders. After adjustment for traditional risk factors, monogenic kidney disorders were associated with an increased risk of kidney failure (hazard ratio [HR] = 1.72), higher rate of eGFR decline (-3.06 vs. 0.25 mL/min/1.73 [m.sup.2]/year), and lower risk of complete remission ([odds ratio.sub.Not achieving CR] = 5.25). High-risk APOL1 genotypes were associated with an increased risk of kidney failure (HR = 1.67) and faster eGFR decline (-2.28 vs. 0.25 mL/min/1.73 [m.sup.2]), replicating prior findings. ACMG SFs were not associated with personal or family history of associated diseases, but were predicted to impact care in 70% of cases. CONCLUSIONS. Monogenic kidney disorders were associated with an increased risk of kidney failure, faster eGFR decline, and lower rates of complete remission, suggesting opportunities for early identification and intervention based on molecular diagnosis. TRIAL REGISTRATION. NA. FUNDING. National Institute of Diabetes and Digestive and Kidney Diseases grants U24DK100845 (formerly UM1DK100845), U01DK100846 (formerly UM1DK100846), U01DK100876 (formerly UM1DK100876), U01DK100866 (formerly UM1DK100866), U01DK100867 (formerly UM1DK100867), U24DK100845, DK081943, RC2DK116690, 2U01DK100876, 1R01DK136765, 5R01DK082753, and RC2-DK122397; NephCure Kidney International; Department of Defense Research Awards PR201425, W81XWH-16-1-0451, and W81XWH-22-1-0966; National Center for Advancing Translational Sciences grant UL1TR001873; National Library of Medicine grant R01LM013061; National Human Genome Research Institute grant 2U01HG008680.

Brain atlases are important reference resources for accurate anatomical description of neuroscience data. Open access, three-dimensional atlases serve as spatial frameworks for integrating experimental data and defining regions-of-interest in analytic workflows. However, naming conventions, parcellation criteria, area definitions, and underlying mapping methodologies differ considerably between atlases and across atlas versions. This lack of standardized description impedes use of atlases in analytic tools and registration of data to different atlases. To establish a machine-readable standard for representing brain atlases, we identified four fundamental atlas elements, defined their relations, and created an ontology model. Here we present our Atlas Ontology Model (AtOM) and exemplify its use by applying it to mouse, rat, and human brain atlases. We discuss how AtOM can facilitate atlas interoperability and data integration, thereby increasing compliance with the FAIR guiding principles. AtOM provides a standardized framework for communication and use of brain atlases to create, use, and refer to specific atlas elements and versions. We argue that AtOM will accelerate analysis, sharing, and reuse of neuroscience data.

BackgroundEvaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).MethodsUsing previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.ResultsThe ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.ConclusionThis review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Climate-driven changes in hydrological regimes are of global importance and are particularly significant in riparian ecosystems. Riparian ecosystems in California provide refuge to many native and vulnerable species within a xeric landscape. California Tetragnatha spiders play a key role in riparian ecosystems, serving as a link between terrestrial and aquatic elements. Their tight reliance on water paired with the widespread distributions of many species make them ideal candidates to better understand the relative role of waterways versus geographic distance in shaping the population structure of riparian species. To assist in better understanding population structure, we constructed a reference genome assembly for Tetragnatha versicolor using long-read sequencing, scaffolded with proximity ligation Omni-C data. The near-chromosome-level assembly is comprised of 174 scaffolds spanning 1.06 Gb pairs, with a scaffold N50 of 64.1 Mb pairs and BUSCO completeness of 97.6%. This reference genome will facilitate future study of T. versicolor population structure associated with the rapidly changing environment of California.

ImportanceEvidence is lacking from randomized clinical trials of hypoglossal nerve stimulation in obstructive sleep apnea (OSA).ObjectiveTo evaluate the safety and effectiveness of targeted hypoglossal nerve stimulation (THN) of the proximal hypoglossal nerve in patients with OSA.Design, setting, and participantsThis randomized clinical trial (THN3) was conducted at 20 centers and included 138 patients with moderate to severe OSA with an apnea-hypopnea index (AHI) of 20 to 65 events per hour and body mass index (calculated as weight in kilograms divided by height in meters squared) of 35 or less. The trial was conducted from May 2015 through June 2018. Data were analyzed from January 2022 through January 2023.InterventionImplant with THN system; randomized 2:1 to activation at month 1 (treatment) or month 4 (control). All received 11 months of THN with follow-up at months 12 and 15, respectively.Main outcomes and measuresPrimary effectiveness end points comprised AHI and oxygen desaturation index (ODI) responder rates (RRs). Treatment responses at months 4 and 12/15 were defined as a 50% or greater reduction in AHI to 20 or less per hour and an ODI decrease of 25% or greater. Coprimary end points comprised (1) month 4 AHI and ODI RR in the treatment greater than the control group and (2) month 12/15 AHI and ODI RR in the entire cohort exceeding 50%. Secondary end points included sleep apnea severity (AHI and ODI) and patient-reported outcomes (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, and EQ-5D visual analog scale).ResultsAmong 138 participants, the mean (SD) age was 56 (9) years, and 19 (13.8%) were women. Month 4 THN RRs were substantially greater in those in the treatment vs control group (AHI, 52.3% vs 19.6%; ODI, 62.5% vs 41.3%, respectively) with treatment-control standardized mean differences of 0.725 (95% CI, 0.360-1.163) and 0.434 (95% CI, 0.070-0.843) for AHI and ODI RRs, respectively. Months 12/15 RRs were 42.5% and 60.4% for AHI and ODI, respectively. Improvements in AHI, ODI, Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, and EQ-5D visual analog scale scores were all clinically meaningful (medium to large effect size). Two serious adverse events and 100 nonserious related adverse events were observed from the implant procedure or study protocol.Conclusions and relevanceThis randomized clinical trial found that THN demonstrated improvements in sleep apnea, sleepiness, and quality of life in patients with OSAs over an extended AHI and body mass index range without prior knowledge of pharyngeal collapse pattern. Clinically meaningful improvements in AHI and patient-reported responses compared favorably with those of distal hypoglossal nerve stimulation trials, although clinically meaningful differences were not definitive for ODI.Trial registrationClinicalTrials.gov Identifier: NCT02263859.

Background: Detailed spectroscopy of neutron-rich, heavy, deformed nuclei is of broad interest for nuclear astrophysics and nuclear structure. Nuclei in the r-process path and following freeze-out region impact the resulting r-process abundance distribution, and the structure of nuclei midshell in both proton and neutron number helps to understand the evolution of subshell gaps and large deformation in these nuclei. Purpose: We aim to improve the understanding of the nuclear structure of Gd160, specifically the Kπ=4+ bands, as well as study the β decay of Eu160 into Gd160. Methods: High-statistics decay spectroscopy of Gd160 resulting from the β-decay of Eu160 was collected using the GRIFFIN spectrometer at the TRIUMF-ISAC facility. Results: Two new excited states and ten new transitions were observed in Gd160. The β-decaying half-lives of the low- and high-spin isomers in Eu160 were determined, and the low-spin state's half-life was measured to be t1/2=26.0(8) s, ≈16% shorter than previous measurements. Lifetimes of the two Kπ=4+ bandheads in Gd160 were measured for the first time, as well as γ-γ angular correlations and mixing ratios of intense transitions out of those bandheads. Conclusions: Lifetimes and mixing ratios suggest that the hexadecapole phonon model of the Kπ=4+ bandheads in Gd160 is preferred over a simple two-state strong mixing scenario, although further theoretical calculations are needed to fully understand these states. Additionally, the 1999.0-keV state in Gd160 heavily populated in β decay is shown to have positive parity, which raises questions regarding the structure of the high-spin β-decaying state in Eu160.