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ObjectivesThe national implementation of competency-based medical education (CBME) has prompted an increased interest in identifying and tracking clinical and educational outcomes for emergency medicine training programs. For the 2019 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, we developed recommendations for measuring outcomes in emergency medicine training in the context of CBME to assist educational leaders and systems designers in program evaluation.MethodsWe conducted a three-phase study to generate educational and clinical outcomes for emergency medicine (EM) education in Canada. First, we elicited expert and community perspectives on the best educational and clinical outcomes through a structured consultation process using a targeted online survey. We then qualitatively analyzed these responses to generate a list of suggested outcomes. Last, we presented these outcomes to a diverse assembly of educators, trainees, and clinicians at the CAEP Academic Symposium for feedback and endorsement through a voting process.ConclusionAcademic Symposium attendees endorsed the measurement and linkage of CBME educational and clinical outcomes. Twenty-five outcomes (15 educational, 10 clinical) were derived from the qualitative analysis of the survey results and the most important short- and long-term outcomes (both educational and clinical) were identified. These outcomes can be used to help measure the impact of CBME on the practice of Emergency Medicine in Canada to ensure that it meets both trainee and patient needs.

Purpose During the severe acute respiratory syndrome coronavirus 2 pandemic, several patient groups are at particular risk. Mortality is higher among cancer patients and may be increased further by thromboembolic events, which are more common in coronavirus 2019 patients according to recent publications. We discuss the association of gynecologic malignancies, Severe acute respiratory syndrome coronavirus 2, and thromboembolism by reporting a case study and summarizing available literature. Case report A 71-year-old Caucasian patient with ovarian cancer receiving first-line chemotherapy was diagnosed with deep vein thrombosis and pulmonary embolism. Routine screening revealed infection with severe acute respiratory syndrome coronavirus 2 in absence of specific symptoms. After uneventful recovery, oncologic treatment could be continued a few weeks later. Methods We performed a systematic review of the literature on PubMed following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The search included articles ahead of print, published between 1 December 2019 and 1 June 2020. Cross-searches were conducted on all relevant articles. Results We identified five articles meeting the defined criteria, including two retrospective studies, a review, a position paper, as well as a letter to the editor. Conclusion Cancer patients infected with severe acute respiratory syndrome coronavirus 2 have a relatively poor outcome, which may partially be due to a higher rate of thromboembolic events. Thromboprophylaxis is recommended, and scoring systems are helpful in early detection. In cancer patients with severe acute respiratory syndrome coronavirus 2, individual risk for thromboembolic events should be taken into account when considering interruption versus continuation of antitumoral therapy. However, further data and studies are required.

ObjectivesThe Royal College of Physicians and Surgeons of Canada (RCPSC) emergency medicine (EM) programs transitioned to the Competence by Design training framework in July 2018. Prior to this transition, a nation-wide survey was conducted to gain a better understanding of EM faculty and senior resident attitudes towards the implementation of this new program of assessment.MethodsA multi-site, cross-sectional needs assessment survey was conducted. We aimed to document perceptions about competency-based medical education, attitudes towards implementation, perceived/prompted/unperceived faculty development needs. EM faculty and senior residents were nominated by program directors across RCPSC EM programs. Simple descriptive statistics were used to analyse the data.ResultsBetween February and April 2018, 47 participants completed the survey (58.8% response rate). Most respondents (89.4%) thought learners should receive feedback during every shift; 55.3% felt that they provided adequate feedback. Many respondents (78.7%) felt that the ED would allow for direct observation, and most (91.5%) participants were confident that they could incorporate workplace-based assessments (WBAs). Although a fair number of respondents (44.7%) felt that Competence by Design would not impact patient care, some (17.0%) were worried that it may negatively impact it. Perceived faculty development priorities included feedback delivery, completing WBAs, and resident promotion decisions.ConclusionsRCPSC EM faculty have positive attitudes towards competency-based medical education-relevant concepts such as feedback and opportunities for direct observation via WBAs. Perceived threats to Competence by Design implementation included concerns that patient care and trainee education might be negatively impacted. Faculty development should concentrate on further developing supervisors’ teaching skills, focusing on feedback using WBAs.

Pulmonary veins carry oxygenated blood from lungs to the left atrium of the heart. The anatomy of the pulmonary veins is variable with some anatomic variants. In clinical practice the difference between the normal anatomy of pulmonary veins with its variants and abnormal anatomy is very important for clinicians. Variants of pulmonary veins may occur in number, diameter and normal venous return. We present a case report and a review of the literature with the pulmonary venous return that deviates from the usual anatomical configuration and ranges from normal variant drainage to anomalous pulmonary—systemic communication. Initially, it was considered as an anatomical variant of the pulmonary venous return associated with the persistence of the left superior vena cava. Upon detailed exploration it was established that it was an anomaly of the pulmonary venous return which led in time to the installation of its complications. Diagnosis can be difficult, sometimes missed, or only made late in adulthood when complications were installed. Knowledge of variant anatomy and anomalous pulmonary venous return play a crucial role in the diagnostically challenging patient.

Aim of the study: Test anxiety expresses itself in a variety of physical and cognitive processes. Due to its influence on test performance, the cognitive component in particular can have a negative impact on those affected. A measuring instrument for this is not yet available in the German-speaking world but does exist in the form of the “Cognitive Test Anxiety Scale” (CTAS), among other languages, in English. The aim of this work was the creation and psychometric review of a German version of the scale (G-CTAS). Methods: A German translation of the scale was created using a forward-backward procedure. Statistical investigations were then carried out on a cohort of medical students, which included an item analysis with calculation of difficulty, variance and item discrimination as well as the determination of the scale’s internal consistency. The criterion validity was examined using test performance and gender-specific differences. Results: The final version contains 26 matching items with acceptable item parameters (mean values >1.46, 0.48; part-whole-discrimination-indices >0.37). Cronbach's alpha was 0.92, the scale was therefore found to be a reliable measuring instrument. The scale validity could be confirmed by significant differences (p, Zielsetzung: Prüfungsangst äußert sich in einer Vielzahl körperlicher und kognitiver Prozesse. Durch ihren Einfluss auf Prüfungsleistungen kann sich besonders die kognitive Prüfungsangstkomponente negativ auf Betroffene auswirken. Ein Messinstrument hierfür ist im deutschen Sprachraum bisher nicht verfügbar, existiert aber in Form der „Cognitive Test Anxiety Scale“ (CTAS) unter anderem in englischer Sprache. Ziel dieser Arbeit war die Erstellung und psychometrische Überprüfung einer deutschen Version der Skala (G-CTAS). Methodik: Mithilfe eines Vorwärts-Rückwärts-Verfahrens wurde eine deutsche Übersetzung der Skala erstellt. An einer Kohorte Humanmedizinstudierender wurden anschließend statistische Untersuchungen durchgeführt, welche eine Itemanalyse mit Berechnung von Schwierigkeit, Varianz und Trennschärfe sowie die Ermittlung der internen Skalenkonsistenz beinhalteten. Eine Überprüfung der Kriteriumsvalidität erfolgte über Prüfungsleistungen sowie geschlechtsspezifische Unterschiede. Ergebnisse: Die finale Version enthält 26 inhaltlich passende Items mit akzeptablen Itemkennwerten (Mittelwerte >1,46, 0,48; Trennschärfeindices >0,37). Cronbach’s alpha betrug 0,92, die Skala stellt somit ein reliables Messinstrument dar. Die Skalenvalidität konnte durch signifikante Unterschiede (p, GMS Journal for Medical Education; 37(5):Doc50

From the P. Oxy. XLII 3055 dated « Year 1 of Diokles » and from the reputation of Diqlot (Diocles) in Palestine as remembered in the rabbinic tradition, we retain that the authority of the new Augustus was recognized in the East under the name of C. Valerius Diocles. The cognomen Diokles, -etos attested in this papyrus shows that Diocletianus was derived from the stem Dioklet-, and refutes the hypothesis recently supported of the Illyrian origin of the last emperor’s cognomen. The same P. Oxy. 3055 leads to establishing the date of the recognition in Egypt of the Augustus Diocles probably in December 284, and to clarifying the chronology of the two successive prefects Pomponius Ianuarianus and M. Aurelius Diogenes. The first emperor’s name Caius Valerius Diocle was replaced in December 284 or in January 285 by the second, Caius Valerius Diocletianus, the only name used after the abandonment of Diocles and until the proclamation of Maximianus, and we propose a new restoration on this topic to the inscripti...

Similarity search in large sequence databases is a problem ubiquitous in a wide range of application domains, including searching biological sequences. In this paper we focus on protein and DNA data, and we propose a novel approximate method method for speeding up range queries under the edit distance. Our method works in a filter-and-refine manner, and its key novelty is a query-sensitive mapping that transforms the original string space to a new string space of reduced dimensionality. Specifically, it first identifies the $$t$$t most frequent codewords in the query, and then uses these codewords to convert both the query and the database to a more compact representation. This is achieved by replacing every occurrence of each codeword with a new letter and by removing the remaining parts of the strings. Using this new representation, our method identifies a set of candidate matches that are likely to satisfy the range query, and finally refines these candidates in the original space. The main advantage of our method, compared to alternative methods for whole sequence matching under the edit distance, is that it does not require any training to create the mapping, and it can handle large query lengths with negligible losses in accuracy. Our experimental evaluation demonstrates that, for higher range values and large query sizes, our method produces significantly lower costs and runtimes compared to two state-of-the-art competitor methods.

Introduction: In July 2018, Emergency Medicine (EM) transitioned to the Royal College of Physicians and Surgeons of Canada's (RCPSC) Competence by Design (CBD) training framework. In anticipation of CBD implementation, we conducted a nation-wide needs assessment of EM faculty and senior residents to understand their attitudes towards CBD, workplace-based assessments (WBA) and overall educational needs. Methods: A multi-site, cross-sectional digital survey was conducted in winter 2018 with a sample of EM faculty and senior residents across RCPSC EM programs in Canada. Recruitment was via program director nomination. Survey domains included baseline perceptions about CBD, attitudes toward implementation, perceived/prompted and unperceived faculty development needs. Microsoft Excel was used to calculate descriptive statistics. This study was reviewed by the Hamilton Integrated Research Ethics Board.A multi-site, cross-sectional digital survey was conducted in winter 2018 with a sample of EM faculty and senior residents across RCPSC EM programs in Canada. Recruitment was via program director nomination. Survey domains included baseline perceptions about CBD, attitudes toward implementation, perceived/prompted and unperceived faculty development needs. Microsoft Excel was used to calculate descriptive statistics. This study was reviewed by the Hamilton Integrated Research Ethics Board. Results: Between February-April 2018, 47 participants (40 faculty, 7 residents) completed the survey (58.8% response rate). Most respondents (89.4%) thought learner feedback should be provided on each shift; 55.3% believed they provided adequate feedback. Time constraints, learner disinterest and fear of assessment repercussions were the top three barriers to providing good feedback. A majority of respondents (78.7%) thought that the ED provided above average opportunities for direct observation and 91.5% were confident of incorporating WBAs into their practice. 44.7% reported that CBD will not impact patient care; 17.0% perceived it may have a negative impact. 55.3% felt that CBD will lead to improved feedback for trainees. The top areas for faculty development were: feedback delivery, completing WBAs, resident promotion decisions, and receiving feedback on teaching. Only 25.5% were interested in learning about CBD, although the average of correct responses on the CBD knowledge test was 44.6%. Conclusion: EM is well-situated to transition to CBD given clinicians’ positive attitudes towards feedback, direct observation, WBAs, and opportunities for direct observation. Threats to CBD implementation are concerns about effects on patient care and trainee education, and skepticism regarding effects on feedback quality. Faculty development should concentrate on further developing clinical teaching and supervision skills, focusing on feedback and WBAs.

A novel metric for time series, called Move-Split-Merge (MSM), is proposed. This metric uses as building blocks three fundamental operations: Move, Split, and Merge, which can be applied in sequence to transform any time series into any other time series. A Move operation changes the value of a single element, a Split operation converts a single element into two consecutive elements, and a Merge operation merges two consecutive elements into one. Each operation has an associated cost, and the MSM distance between two time series is defined to be the cost of the cheapest sequence of operations that transforms the first time series into the second one. An efficient, quadratic-time algorithm is provided for computing the MSM distance. MSM has the desirable properties of being metric, in contrast to the Dynamic Time Warping (DTW) distance, and invariant to the choice of origin, in contrast to the Edit Distance with Real Penalty (ERP) metric. At the same time, experiments with public time series data sets demonstrate that MSM is a meaningful distance measure, that oftentimes leads to lower nearest neighbor classification error rate compared to DTW and ERP.

Purpose The aim of the study was to determine whether the number of procedures performed by residents and medical students in the emergency department (ED) is affected by ED crowding. Methods In this single-center, prospective, observational study, standardized data collection forms were completed by both trainees and supervising emergency physicians (EPs) at the end of each ED shift from August 2009 to March 2010. Shifts with no trainees were excluded. All procedures that were offered to a trainee were recorded as well as the number of potential ED procedures that were, instead, referred to a consulting service. Emergency department crowding was measured in 2 ways: ED length of stay (LOS) and the EP's assessment of crowding during the shift. Poisson regression was used to assess the adjusted effect of ED crowding on the number of trainee procedures performed as well as on the number of procedures given away. Results There were 804 procedures performed by 113 trainees during 647 trainee shifts. Medical students comprised 51% of trainees. Median number of procedures performed per shift was 1.0 (Fine interquartile range, 0-2.0). Emergency department crowding was not associated with the adjusted number of procedures trainees performed using either the EP's assessment of crowding ( P = .52) or ED LOS ( P = .84). Emergency department crowding was associated with an adjusted 256% increase in the mean number of procedures given away ( P = .02) when measured using physician assessment but was not associated with crowding when assessed using ED LOS ( P = .06). Conclusions Crowding was not significantly associated with the number of procedures availed to ED trainees. In patients being considered for admission, however, when the managing EP felt that it was crowded, there was an association with giving procedures to consulting services.

Background: Real-time use of procedure videos as educational tools has not been studied. We sought to determine whether viewing a video of a medical procedure prior to procedure performance in the emergency department improves the quality of teaching of procedures, and whether videos are particularly beneficial during periods of emergency department crowding. Methods: In this single-centre, prospective, before and after study standardized data collection forms were completed by both trainees and supervising emergency physicians (EPs) at the end of each emergency department shift in the before (August 2008-March 2009) and after (August 2009-March 2010) phase. Online procedure videos were introduced on emergency department computers in the after phase. The primary outcome measure was EP rating of the quality of teaching provided (5-point Likert scale). The interaction between crowding and videos was also assessed, to determine whether videos provide a specific additional benefit during periods of emergency department crowding. Results: There were 1159 procedures performed by 192 trainees. Median procedures performed per shift was 1.0 (IQR 0 - 2.0). Mean EP rating of teaching provided was significantly higher in the group that viewed videos, at 4.2 versus 3.7 (p 0.001). In the adjusted analysis, EP ratings increased by 0.5 with a video (p 0.001), while the odds of a score of 5.0 were 2.2 times greater if a video was viewed (p = 0.03). The interaction of crowding and procedure videos was not significant (the use of videos increased the average score by 0.24 in times of crowding compared to times of non-crowding, p = 0.19). Conclusions: Use of procedural videos was associated with EP perception of improved quality of teaching provided around procedures. While EPs rated the quality of their teaching as improved overall, the effect of videos on teaching quality was the same in crowded settings as it was in non-crowded setting.

Gestures are an important modality for human---machine communication. Computer vision modules performing gesture recognition can be important components of intelligent homes, assistive environments, and human---computer interfaces. A key problem in recognizing gestures is that the appearance of a gesture can vary widely depending on variables such as the person performing the gesture, or the position and orientation of the camera. This paper presents a database-based approach for addressing this problem. The large variability in appearance among different examples of the same gesture is addressed by creating large gesture databases, that store enough exemplars from each gesture to capture the variability within that gesture. This database-based approach is applied to two gesture recognition problems: handshape categorization and motion-based recognition of American Sign Language signs. A key aspect of our approach is the use of database indexing methods, in order to address the challenge of searching large databases without violating the time constraints of an online interactive system, where system response times of over a few seconds are oftentimes considered unacceptable. Our experiments demonstrate the benefits of the proposed database-based framework, and the feasibility of integrating large gesture databases into online interacting systems.

An interpretative study of a group of inscriptions, corroborated by numismatic and papyrological data, throws light on some aspects of the crisis of the imperial college that have been omitted by the litterary tradition and enables to propose a more precise view of the date, circumstances and immediate consequences of Constantine’s elevation to the rank of Augustus. Thus, two milliaries from Cilicia which we date in november 307 celebrate a college made up of the Augusti Maximian and Galerius and the Caesars Maximinus and Constantine. In the same way as the contemporary coins and papyri, they reveal several features of the politics displayed by Maximin between 307 and 309, among which especially his obvious opposition to Galerius following the later’s refusal to promote him Augustus in place of Severus who died on 16 september 307, equally his unfailing support to Maximian’s come back to the ruling team as first Augustus and the political alliance formed in november 307 with Maximian and Constantine. The ...

The first part of this study has revised ten inscriptions mentioning the title Filius Augustorum that styled Maximinus and Constantine between 308 and 310 (AnTard, 12); this second part now demonstrates that this new title corresponded to a new imperial rank, and clarifies its chronology and its political implications. According to the inscriptions, the coins and the papyri, that confirm Lactantius’ assertion (De mort. persec., 32. 4), it appears that Galerius replaced the rank of Caesar by that of Filius Augustorum, which was halfway between that of Caesar and that of Augustus. The new imperial title offered a new definition of the divine filiation of Maximinus and Constantine, which served political purposes; it was the last of the series established after 305, and was set up as quite symetrical to that of Pater Augustorum which styled Diocletian as consul that very year 308. The assumption that Galerius established the new rank towards the 20th of December 308 was made possible by the examination of th...

Ten Greek and Latin inscriptions which make use of the title Filius Augustorum are here under examination; they invite us to reopen a study of the fourth tetrarchic college which will be continued in a second part. In this first part, most of these epigraphs are reedited with textual emendations and for all of them more precise datings and historical interpretations are proposed. In order to check the previous views that the title Filius Augustorum was instituted on the 11th of November 308, merely as a quite unimportant addition to the title Caesar, it proved necessary, in such a period of deep disagreements, to relate each document to its originating from a specific political area. This approach to the problem allowed us to attach a chronological meaning to some differences attested in Maximinus’ and Constantine’s imperial titulatures. Since most of these inscriptions style those two emperors either as Caesar (n. 1-2) or as Filius Augustorum (n . 3-8), while mainly originating from the regions submitted...

Five platinum pyridin-2-ylcarboxaldimine complexes of the type cis-[PtCl2(2-C5H4NCH=NR)] (R = CH2CH2OH (1); R = N(CH2CH2)2O (2); R = C6H5 (3); R = 1-C10H7 (4); R = (CH2)8CH=CH(CH2)7CH3 (5)) were prepared and their in vitro reactivity towards a 20-base pair (single- and double-stranded) DNA determined using nuclease digest studies and RP-HPLC. Variation of the imine functionality allowed for the design of compounds with different physical and chemical properties. Complexes 1 and 3 showed binding to both single- and double-stranded DNA comparable to that of cisplatin (cis-[PtCl2(NH3)2]). Crystals of 1 were monoclinic, space group P2(1)/n, a = 9.6612 (15), b = 12.9678 (19), c = 9.7004(13) Å, β = 117.73(3)°, Z = 4.Key words: platinum, pyridin-2-ylcarboxaldimines, DNA binding studies.

Taylor dispersion and differential refractometry are used to measure mutual diffusion coefficients (D) for the binary mixtures 1,4-dioxane + water, 1,3-dioxolane + water, and tetrahydrofuran + water at 25 °C. For each of these systems the plot of D against composition shows a pronounced minimum. Activity and viscosity data for aqueous 1,4-dioxane are used to discuss the strong composition dependence of D in terms of changes in the mobilities and thermodynamic driving forces. Diffusion coefficients are also reported for dilute aqueous solutions of 1,3-dioxane, tetrahydropyran, and trioxane. The limiting diffusion coefficients of the infinitely dilute aqueous ethers are discussed in terms of ring size, number and relative location of the oxygens, and the ether partial molar volume. A second or a third oxygen in the five- or six-membered rings reduces the ether partial molar volumes by about 10 cm3·mol-1 and increases the limiting diffusion coefficients by (0.14 to 0.21) × 10-5 cm2·s-1.

A method is presented to help users look up the meaning of an unknown sign from American Sign Language (ASL). The user submits a video of the unknown sign as a query, and the system retrieves the most similar signs from a database of sign videos. The user then reviews the retrieved videos to identify the video displaying the sign of interest. Hands are detected in a semi-automatic way: the system performs some hand detection and tracking, and the user has the option to verify and correct the detected hand locations. Features are extracted based on hand motion and hand appearance. Similarity between signs is measured by combining dynamic time warping (DTW) scores, which are based on hand motion, with a simple similarity measure based on hand appearance. In user-independent experiments, with a system vocabulary of 1,113 signs, the correct sign was included in the top 10 matches for 78% of the test queries.

This paper describes work towards designing a computer vision system for helping users look up the meaning of a sign. Sign lookup is treated as a video database retrieval problem. A video database is utilized that contains one or more video examples for each sign, for a large number of signs (close to 1000 in our current experiments). The emphasis of this paper is on evaluating the trade-offs between a non-automated approach, where the user manually specifies hand locations in the input video, and a fully automated approach, where hand locations are determined using a computer vision module, thus introducing inaccuracies into the sign retrieval process. We experimentally evaluate both approaches and present their respective advantages and disadvantages.

Boosted one-versus-all (OVA) classifiers are commonly used in multiclass problems, such as generic object recognition, biometrics-based identification, or gesture recognition. JointBoost is a recently proposed method where OVA classifiers are trained jointly and are forced to share features. JointBoost has been demonstrated to lead both to higher accuracy and smaller classification time, compared to using OVA classifiers that were trained independently and without sharing features. However, even with the improved efficiency of JointBoost, the time complexity of OVA-based multiclass recognition is still linear to the number of classes, and can lead to prohibitively large running times in domains with a very large number of classes. In this paper, it is shown that JointBoost-based recognition can be reduced, at classification time, to nearest neighbor search in a vector space. Using this reduction, we propose a simple and easy-to-implement vector indexing scheme based on principal component analysis (PCA). In our experiments, the proposed method achieves a speedup of two orders of magnitude over standard JointBoost classification, in a hand pose recognition system where the number of classes is close to 50,000, with negligible loss in classification accuracy. Our method also yields promising results in experiments on the widely used FRGC-2 face recognition dataset, where the number of classes is 535.

When we encounter an English word that we do not understand, we can look it up in a dictionary. However, when an American Sign Language (ASL) user encounters an unknown sign, looking up the meaning of that sign is not a straightforward process. It has been recently proposed that this problem can be addressed using a computer vision system that helps users look up the meaning of a sign. In that approach, sign lookup can be treated as a video database retrieval problem. When the user encounters an unknown sign, the user provides a video example of that sign as a query, so as to retrieve the most similar signs in the database. A necessary component of such a sign lookup system is a similarity measure for comparing sign videos. Given a query video of a specific sign, the similarity measure should assign high similarity values to videos from the same sign, and low similarity values to videos from other signs. This paper evaluates a state-of-the-art video-based similarity measure called Dynamic Space-Time Warping (DSTW) for the purposes of sign retrieval. The paper also discusses how to specifically adapt DSTW so as to tolerate differences in translation and scale.

Gestures are a natural means of communication between humans, and also a natural modality for human-computer interaction. Automatic recognition of gestures using computer vision is an important task in many real-world applications, such as sign language recognition, computer games control, virtual reality, intelligent homes, and assistive environments. In order for a gesture recognition system to be robust and deployable in non-laboratory settings, the system needs to be able to operate in complex scenes, with complicated backgrounds and multiple moving and skin-colored objects. In this paper we propose an approach for improving gesture recognition performance in such complex environments. The key idea is to integrate a face detection module into the gesture recognition system, and use the face location and size to make gesture recognition invariant to scale and translation. Our experiments demonstrate the significant advantages of the proposed method over alternative computer vision methods for gesture recognition.

Stefan Alexandra. Dédicace de Tomi en l'honneur de Trajan (ISM II, 38 et 42). In: Revue des Études Grecques, tome 104, fascicule 497-499, Juillet-décembre 1991. pp. 574-583.