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Background: To prepare engineers who can address complex sociotechnical problems, a deep understanding of engineers' complex problem-solving approaches is needed. Purpose/Hypothesis: This study operationalizes comprehensive systems thinking as an analysis framework that attends to aspects of engineering work and relationships among those aspects. Leveraging this framework to analyze engineers' complex problem-solving approaches enables attention to social and technical dimensions. Design/Method: We interviewed 46 engineers about their specific complex problem-solving experiences. To explore a range of perspectives, we purposely sampled participants with varying academic, professional, and personal backgrounds and experiences. Data analysis focused on operationalizing comprehensive systems thinking; we first developed a set of aspects that captured the variety of considerations that participants discussed in their descriptions of solving a complex problem. We then inductively developed a scoring guide to differentiate response quality. Results: The scoring approach differentiated the quality of consideration based on a combination of the number of details provided, the degree of specificity, and analytical depth. While most participants discussed the consideration of a wide range of aspects of engineering work, they discussed far fewer possible relationships between these aspects. Contextual aspects of engineering work were consistently the least commonly identified and least likely to be considered in relation to other aspects of a given problem. Conclusions: Our differentiation of various complex problem-solving approaches can guide the development of educational interventions and tools, ultimately facilitating more comprehensive consideration of aspects--and in particular relationships among aspects--and setting up engineers to be more successful at developing appropriate solutions.

Background Despite improvement in devices, in‐stent restenosis remains a frequent and challenging complication of percutaneous coronary interventions. Methods and Results The RESTO (Morphological Parameters of In‐Stent Restenosis Assessed and Identified by OCT [Optical Coherence Tomography]; study NCT04268875) was a prospective multicenter registry including patients presenting with coronary syndromes related to in‐stent restenosis. All patients underwent preintervention OCT analysis, which led to analysis of in‐stent restenosis phenotype, number of strut layers, and presence of stent underexpansion. The primary end point was the in‐stent restenosis type according to the OCT morphological classification. The 1‐year incidence of target vessel failure (a composite of death from cardiac causes, target‐vessel myocardial infarction, or ischemia‐driven target‐vessel revascularization) was assessed. The study included 297 patients. The culprit stent was a drug‐eluting stent in 74.2% of cases. OCT analysis revealed the presence of neoatherosclerosis in 57% (52% calcified), neointimal hyperplasia in 43% (58% homogeneous), stent underexpansion (minimal stent area

El movimiento de las personas depende de la acción del sistema nervioso sobre grupos musculares específicos que se apoyan sobre la estructura ósea. Algunos procesos patológicos pueden causar alteraciones de la fuerza y coordinación que debe existir entre las respuestas musculares, causando alteraciones en el movimiento esperado. En su fase inicial, la mayoría de estas alteraciones pasan desapercibidas hasta que los daños físicos afectan notoriamente la actividad humana, y en muchos casos de manera irreparable. Actualmente, el método más utilizado para el análisis de la marcha humana se basa en el estudio fotométrico secuencial en espacio limitado, aunque en menor medida también se utilizan sistemas de posicionamiento digital. Este proyecto aborda el desarrollo de tecnología para la captura biométrica del movimiento humano mediante sensores de medición inercial. La idea es detallar el desplazamiento espacial de secciones específicas del cuerpo a partir de la medición de aceleración y la velocidad angular, con el propósito de valorar la respuesta de las articulaciones involucradas. El objetivo es desarrollar un sistema que permita a los médicos especialistas identificar anomalías en el movimiento del paciente en estudio. Los resultados preliminares demuestran la eficiencia del sensor inercial implementado. Utilizando 7 sensores ubicados estratégicamente en el cuerpo del paciente y con una velocidad de adquisición de 100 muestras por segundo en cada sensor, es posible detallar movimientos de marcha menores a 7,5 milímetros y precisión en velocidad angular de hasta 0,1°/0,01 segundo. Con el desarrollo de este instrumento se consigue la capacidad de visualizar y analizar movimientos que normalmente son imperceptibles para el ojo humano.

Abstract Conflicting results remain on the impacts of climate change on marine organisms, hindering our capacity to predict the future state of marine ecosystems. To account for species-specific responses and for the ambiguous relation of most metrics to fitness, we develop a meta-analytical approach based on the deviation of responses from reference values (absolute change) to complement meta-analyses of directional (relative) changes in responses. Using this approach, we evaluate responses of fish and invertebrates to warming and acidification. We find that climate drivers induce directional changes in calcification, survival, and metabolism, and significant deviations in twice as many biological responses, including physiology, reproduction, behavior, and development. Widespread deviations of responses are detected even under moderate intensity levels of warming and acidification, while directional changes are mostly limited to more severe intensity levels. Because such deviations may result in ecological shifts impacting ecosystem structures and processes, our results suggest that climate change will likely have stronger impacts than those previously predicted based on directional changes alone.

Lithodes santolla (SKC) and Paralomis granulosa (FSKC) are economically important resources exploited in southern South America. The effect of refrigerated storage (4 °C on flake ice) on physico-chemical (pH, thiobarbituric reactive substances (TBARs), total volatile basic nitrogen (TVB-N), water holding capacity (WHC), and water content (WC)), microbiological (total viable mesophilic bacteria (TVMC), psychrotrophic bacteria (TVPC), Staphylococcus spp, coliforms, enterobacteria, molds and yeasts) and sensory (odor, appearance, texture, juiciness, and taste) parameters was analyzed in the cooked SKC and FSKC merus. For each species, cooked merus from 36 animals were randomly distributed into 6 groups, corresponding to 0, 2, 5, 8, 11, and 14 days of storage. On each day, samples were taken for physico-chemical (n = 6), microbiological (n = 3), and sensory (n = 15) analyses. The pH values increased over time (P 0.05) in all cases. The presence of TVCM, TVCP, and Staphylococcus spp. in both species was observed from day 0. Furthermore, pathogenic microorganisms (S. aureus, coliforms, and enterobacteria) were not detected, and only the TVCP in SFKC reached the suggested microbial limit after 11 days. All sensory scores significantly decreased (P

Background: Personal characteristics (e.g., race/ethnicity, gender, and precollege experiences) are known to shape students' pathways to engineering, as well as persistence decisions in college. However, the role of psychological cost in postgraduation intentions has received less scholarly attention. Purpose: The purpose of this study is to examine sociocognitive factors that shape students' postgraduation intentions in the early college years. Guided by Social Cognitive Career Theory and the concept of psychological cost, we examine the role of self-efficacy beliefs, outcome expectations, and psychological cost, as well as key background characteristics, in students' postgraduation intentions. Method: We analyzed survey responses from four cohorts of undergraduate engineering students at a large public university. Participants responded to items measuring self-efficacy beliefs, outcome expectations, and psychological cost after their first and second years of college. We used structural equation modeling to examine the relationships between the sociocognitive variables and students' graduate school and career intentions. Results: The sociocognitive variables predicting postgraduation intentions after Year 1 differed from those predicting intentions after Year 2. After Year 1, we found no statistically significant sociocognitive variables predicting graduate school intentions or engineering career plans. After Year 2, both self-efficacy and outcome expectations were significant predictors of postgraduation intentions. The psychological cost was significantly related to both self-efficacy and outcome expectations. Finally, we found significant differences in racial/ethnic identity, sex, and first-generation status. Conclusion: Examining psychological cost provides additional insights into the factors informing students' postgraduation intentions over the course of their collegiate careers and suggests new directions for research on students' thinking about engineering careers.

Abstract Aims Impact of skin mottling has been poorly studied in patients admitted for cardiogenic shock. This study aimed to address this issue and identify determinants of 30-day and 1-year mortality in a large cardiogenic shock cohort of all etiologies. Methods and results FRENSHOCK is a prospective multicenter observational registry conducted in French critical care units between April and October, 2016. Among the 772 enrolled patients (mean age 65.7 ± 14.9 years; 71.5% male), 660 had skin mottling assessed at admission (85.5%) with almost 39% of patients in cardiogenic shock presenting mottling. The need for invasive respiratory support was significantly higher in patients with mottling (50.2% vs. 30.1%, p

Background The effects of pharmacological therapy on cardiogenic shock (CS) survivors have not been extensively studied. Thus, this study investigated the association between guideline‐directed heart failure (HF) medical therapy (GDMT) and one‐year survival rate in patients who are post‐CS. Methods and Results FRENSHOCK (French Observatory on the Management of Cardiogenic Shock in 2016) registry was a prospective multicenter observational survey, conducted in metropolitan French intensive care units and intensive cardiac care units. Of 772 patients, 535 patients were enrolled in the present analysis following the exclusion of 217 in‐hospital deaths and 20 patients with missing medical records. Patients with triple GDMT (beta‐blockers, renin‐angiotensin system inhibitors, and mineralocorticoid receptor antagonists) at discharge (n=112) were likely to have lower left ventricular ejection fraction on admission and at discharge compared with those without triple GDMT (n=423) (22% versus 28%, P

Conclusion: Despite a higher risk profile of patients in the SC group, SC and PC approaches appear safe and effective in TF TAVR, with a high success rate. SC may be considered when vascular access is anticipated as complex, but this strategy might be confirmed in a randomized study.

Summary: Background: Smoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events. Methods: From 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097). Findings: Among 1379 patients (63 ± 15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11 parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO > 11 ppm vs. 2.9% for CO ≤ 11 ppm; p 11 ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56–44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06–28.04]). In the overall population, CO > 11 ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33–6.98] and 1.66 [0.96–2.85] respectively). Interpretation: Elevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events. Funding: Grant from Fondation Coeur & Recherche.

A common perception of biomedical engineering (BME) undergraduates is that they struggle to find industry jobs upon graduation. While some statistics support this concern, students continue to pursue and persist through BME degrees. This persistence may relate to graduates' other career interests, though limited research examines where BME students go and why. Scholars are also pushing for research that examines engineering careers in a broader context, beyond traditional industry positions. This study adds to that conversation by asking: How do BME students describe their career interests and perceived job prospects in relation to why they pursue a BME degree? A qualitative study of BME students was performed at a public, R1 institution using semi-structured interviews at three timepoints across an academic year. An open coding data analysis approach explored career-perceptions of students nearing completion of a BME undergraduate degree. Findings indicated that students pursued a BME degree for reasons beyond BME career aspirations, most interestingly as a means to complete an engineering degree that they felt would have interesting enough content to keep them engaged. Participants also discussed the unique career-relevant skills they developed as a BME student, and the career-placement tradeoffs they associated with getting a BME undergraduate degree. Based on these results, we propose research that explores how students move through a BME degree into a career and how career-relevant competencies are communicated in job searches. Additionally, we suggest strategies for BME departments to consider for supporting students through the degree into a career.

BackgroundCardiogenic shock (CS) is the most severe form of heart failure (HF), resulting in high early and long-term mortality. Characteristics of CS secondary to supraventricular tachycardia (SVT) are poorly reported. Based on a large registry of unselected CS, we aimed to compare 1-year outcomes between SVT-triggered and non-SVT-triggered CS.MethodsFRENSHOCK is a French prospective registry including 772 CS patients from 49 centers. For each patient, the investigator could report 1–3 CS triggers from a pre-established list (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance, and others). In this study, 1-year outcomes [rehospitalizations, mortality, heart transplantation (HTx), ventricular assist devices (VAD)] were analyzed and adjusted for independent predictive factors.ResultsAmong 769 CS patients included, 100 were SVT-triggered (13%), of which 65 had SVT as an exclusive trigger (8.5%). SVT-triggered CS patients exhibited a higher proportion of male individuals with a more frequent history of cardiomyopathy or chronic kidney disease and more profound CS (biventricular failure and multiorgan failure). At 1 year, there was no difference in all-cause mortality (43% vs. 45.3%, adjusted HR 0.9 (95% CI 0.59–1.39), p = 0.64), need for HTx or VAD [10% vs. 10%, aOR 0.88 (0.41–1.88), p = 0.74], or rehospitalizations [49.4% vs. 44.4%, aOR 1.24 (0.78–1.98), p = 0.36]. Patients with SVT as an exclusive trigger presented more 1-year rehospitalizations [52.8% vs. 43.3%, aOR 3.74 (1.05–10.5), p = 0.01].ConclusionSVT is a frequent trigger of CS alone or in association in more than 10% of miscellaneous CS cases. Although SVT-triggered CS patients were more comorbid with more pre-existing cardiomyopathies and HF incidences, they presented similar rates of mortality, HTx, and VAD at 1 year, arguing for a better overall prognosis.Clinical Trial Registrationhttps://clinicaltrials.gov, identifier: NCT02703038.

BackgroundAnti-PD1/PD-L1 directed immune checkpoint inhibitors (ICI) are widely used to treat patients with advanced non-small-cell lung cancer (NSCLC). The activity of ICI across NSCLC harboring oncogenic alterations is poorly characterized. The aim of our study was to address the efficacy of ICI in the context of oncogenic addiction.Patients and methodsWe conducted a retrospective study for patients receiving ICI monotherapy for advanced NSCLC with at least one oncogenic driver alteration. Anonymized data were evaluated for clinicopathologic characteristics and outcomes for ICI therapy: best response (RECIST 1.1), progression-free survival (PFS), and overall survival (OS) from ICI initiation. The primary end point was PFS under ICI. Secondary end points were best response (RECIST 1.1) and OS from ICI initiation.ResultsWe studied 551 patients treated in 24 centers from 10 countries. The molecular alterations involved KRAS (n = 271), EGFR (n = 125), BRAF (n = 43), MET (n = 36), HER2 (n = 29), ALK (n = 23), RET (n = 16), ROS1 (n = 7), and multiple drivers (n = 1). Median age was 60 years, gender ratio was 1 : 1, never/former/current smokers were 28%/51%/21%, respectively, and the majority of tumors were adenocarcinoma. The objective response rate by driver alteration was: KRAS = 26%, BRAF = 24%, ROS1 = 17%, MET = 16%, EGFR = 12%, HER2 = 7%, RET = 6%, and ALK = 0%. In the entire cohort, median PFS was 2.8 months, OS 13.3 months, and the best response rate 19%. In a subgroup analysis, median PFS (in months) was 2.1 for EGFR, 3.2 for KRAS, 2.5 for ALK, 3.1 for BRAF, 2.5 for HER2, 2.1 for RET, and 3.4 for MET. In certain subgroups, PFS was positively associated with PD-L1 expression (KRAS, EGFR) and with smoking status (BRAF, HER2).Conclusions: ICI induced regression in some tumors with actionable driver alterations, but clinical activity was lower compared with the KRAS group and the lack of response in the ALK group was notable. Patients with actionable tumor alterations should receive targeted therapies and chemotherapy before considering immunotherapy as a single agent.

Background: Co-curricular student outcomes research has focused on connecting outcomes to activities based on the co-curricular type. Less work has explored what aspects of those co-curricular activities could lead to student outcomes. Purpose: Our research aimed to identify common elements of co-curricular activities that connected to students’ development of professional, career, or personal outcomes and can inform how we study and design co-curricular activities in engineering. Design: We recruited participants from one biomedical engineering (BME) program. We used a one-year series of four semi-structured interviews with fourteen upper-level BME students to explore students’ perceptions of their co-curricular learning. Using a qualitative, causal analysis approach, we identified elements of students’ co-curricular experiences in research or a multi-disciplinary design team, as well as other co-curricular experiences (e.g., internships, professional societies), that linked to professional, career, or personal learning outcomes that have been previously identified as important in engineering education. Findings: We identified patterns of connections between unique “experience elements” and a variety of “outcome categories” through participant activities we called “participant actions.” The most prevalent connections—those experience elements and participant actions that connected to multiple outcome categories—included the experience elements Independent Project Work, Project Work That Engages Multiple Disciplines, STEM Education Opportunities, and Mentorship from a Skilled Other as well as a participant action Reflecting on Experience. We found connections to the outcome categories of Leadership, Design, Business, Interdisciplinary Competence, Disciplinary Competence, Communication, and Career Direction Outcomes. Conclusions: Based on our findings, educators and mentors should consider the value of supporting students’ decision-making autonomy and multidisciplinary interactions in projects to support learning. They could also incorporate opportunities for students to teach each other technical content, receive structured mentorship, and reflect on their experiences as they are happening. Further, this work demonstrates a need to explore co-curricular learning processes in new ways that can lead to better understandings of students’ learning processes.

As some of the most stable and important structures in society, colleges and universities are rarely described as nimble. Yet, when the COVID-19 pandemic hit in March 2020, institutions across the globe not only shifted within days to online instruction, but many academic researchers also immediately launched efforts to understand the virus, identify treatments, produce medical supplies, and study its impacts. While some investigators managed to make progress, other talented researchers lacked timely access to funding for key personnel, lab supplies, and incentives for study participants--the needed fuel for discoveries. Even as researchers have long called for low-barrier processes to accelerate time-sensitive research contributions, the pandemic has painfully underscored the need for rapid responses to pressing societal needs. Experimental programs offer models of the funding mechanisms needed to heighten efficiency, whether in the face of COVID or other ongoing crises. In this article, the authors discuss the shortcomings of the current, widely used peer review process and suggest that Mcubed, a novel token-based review and funding program developed at the University of Michigan (U-M), may offer significant advantages. This article describes the operation of Mcubed over an 8-year period on U-M's three campuses and details the positive results that were obtained, hoping to motivate others to engage in comparable endeavours.

Background: Percutaneous (PC) access has become the first‐line strategy for transfemoral (TF) transcatheter aortic valve replacement (TAVR), but surgical cutdown (SC) may be required in selected and usually challenging cases. We aimed to compare the efficacy and safety of SC versus echo‐guided PC approach in TF TAVR. Methods: Between November 2019 and December 2020, all patients undergoing TF TAVR were included in a prospective study. The choice of PC or SC strategy was left at operators' discretion, according to predictable access site difficulties. The primary endpoint included all vascular complications (VCs) and all bleeding at 1‐month follow‐up according to Valve Academic Research Consortium‐2 criteria. Results: Among 225 patients, 166 (73.8%) and 59 (26.2%) underwent PC or SC approach, respectively. Median age was 82 years, EuroSCORE 2 was higher (p = 0.02), and peripheral arterial disease (p < 0.001) was more common in the SC group. Femoral access was successful in 100% in the SC group vs 97.6% in the PC group (p = 0.2). The primary endpoint was reached in 32 patients (14.2%), 5 (8.4%) in the SC group and 27 (16.2%) in the PC group (p = 0.1) with low incidence of major VC in both groups (1.7% vs 3% in the SC and PC groups respectively, p = 0.6). Conclusion: Despite a higher risk profile of patients in the SC group, SC and PC approaches appear safe and effective in TF TAVR, with a high success rate. SC may be considered when vascular access is anticipated as complex, but this strategy might be confirmed in a randomized study. Trial Registration: ClinicalTrials.gov identifier: NCT03865043 [ABSTRACT FROM AUTHOR]

Background: Systematic revascularization of asymptomatic coronary artery stenosis before transcatheter aortic valve replacement (TAVR) is controversial. Purpose: The purpose of this study was to evaluate the feasibility and safety of functional evaluation of coronary artery disease (CAD) followed by selective ischemia-guided percutaneous coronary revascularization following TAVR. Methods: This prospective, bi-centric, single-arm, open-label trial included all patients with severe aortic stenosis (AS) eligible for TAVR and with significant CAD defined as ≥1 coronary stenosis ≥ 70%. Patients with left main stenosis ≥ 50%, proximal left anterior descending artery (LAD) stenosis ≥ 90% or > class 2 Canadian Classification Society (CCS) angina were excluded. Myocardial ischemia was evaluated by stress cardiac imaging one month after TAVR. The primary endpoint was a composite of all-cause death, stroke, major bleeding (Bleeding Academic Research Consotium ≥ 3), major vascular complication (Valve Academic Research Consortium 3 criteria), acute coronary syndrome (ACS) and hospitalization for cardiac causes within 6 months of receiving TAVR. Results: Between June 2020 and June 2022, 64 patients were included in this study. The mean age was 84 ± 5.2 years. CAD mostly involved LAD (n = 27, 42%) with frequent multivessel disease (n = 30, 47%) and calcified lesions (n = 39, 61%). Stress cardiac imaging could be achieved in 70% (n = 46) of the patients, while 30% (n = 18) did not attend the stress test. Significant myocardial ischemia was observed in only three patients (4.5%). At 6-month follow-up, fifteen patients (23%) reached the primary endpoint, including death in six patients (9%), stroke in three patients (5%) and major bleeding in three patients (5%). ACS was observed in only two patients (3%) but both had severe coronary stenosis (≥90%) and did not refer for stress imaging for personal reasons. Hospital readmission (n = 27, 41%) was mostly related to non-cardiac causes (n = 17, 27%). Conclusions: In patients with asymptomatic CAD scheduled to undergo TAVR, a selective ischemia-guided coronary revascularization after TAVR seems to be safe, with a very low rate of ACS and few cases of myocardial ischemia requiring revascularization, despite low adherence to medical follow-up in this elderly population. This strategy could be evaluated in a randomized study. [ABSTRACT FROM AUTHOR]