Search

Abstract Background Use of the Debriefing Assessment for Simulation in Healthcare (DASH©) would be beneficial for novice debriefers with less or no formal training in debriefing. However, the DASH translated into Korean and tested for psychometrics is not yet available. Thus, this study was to develop a Korean version of the DASH student version (SV) and test its reliability and validity among baccalaureate nursing students in Korea. Methods The participants were 99 baccalaureate nursing students. Content validity using content validity index (CVI), construct validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and internal consistency using Cronbach’s alpha coefficient were assessed. Results Both Item-CVIs and Scale-CVI were acceptable. EFA supported the unidimensional latent structure of Korean DASH-SV and results of CFA indicated 6 items converged within the extracted factor, significantly contributing to the factor (p ≤ .05). Items were internally consistent (Cronbach’s α = 0.82). Conclusion The Korean version of the DASH-SV is arguably a valid and reliable measure of instructor behaviors that could improve faculty debriefing and student learning in the long term.

Background/objectives: Point-of-care ultrasound (POCUS) in the intensive care unit (ICU) has gained much attention in the last few years as an alternative to the classic ways of assessing and diagnosing life-threatening conditions in critical patients. During the COVID-19 pandemic, we proposed a POCUS protocol based on the airway, breathing, and circulation (ABC) approach to quickly evaluate and diagnose life-threatening diseases in critical patients with acute respiratory failure and shock, and later, we used it as a curriculum to teach POCUS to anesthesia and intensive care trainees. Methods: We developed an evaluation protocol where evaluators with experience in POCUS in critically ill patients had to assess the trainee’s ultrasound scan; this was based on the ABC protocol taught in the simulation laboratory and applied in a clinical setting at the bedside. Results: Statistically significant differences were observed in some categories evaluated regarding independence and diagnosis. Conclusion: Initial POCUS simulation-based training using an ABC POCUS protocol (that demonstrated good results in the simulation laboratory) is useful when transferring US skills to the bedside and is applicable in daily clinical practice with good results in terms of operator independence.

Boolean satisfiability (SAT) is a propositional logic problem of determining whether an assignment of variables satisfies a Boolean formula. Many combinatorial optimization problems can be formulated in Boolean SAT logic—either as k -SAT decision problems or Max k -SAT optimization problems, with conflict-driven clause learning (CDCL) solvers being the most prominent. Despite their ability to handle large instances, CDCL-based solvers have fundamental scalability limitations. In light of this, we propose recently-developed quadratic unconstrained binary optimization (QUBO) solvers as an alternative platform for 3-SAT problems. To utilize them, we implement a 2-step [3-SAT]-[Max 2-SAT]-[QUBO] conversion procedure and present a novel approach using linear systems and Diophantine equation to calculate the number of both satisfied and violated clauses of the original 3-SAT instance from the transformed Max 2-SAT formulation. We then demonstrate, through numerical simulations on several benchmark instances, that digital QUBO solvers can achieve state-of-the-art accuracy on 78-variable 3-SAT benchmark problems. Our work facilitates the broader use of quantum annealers on noisy intermediate-scale quantum devices, as well as their quantum-inspired digital counterparts, for solving 3-SAT problems.

Percutaneous tibial neuromodulation is a medical guideline recommended therapy for treating symptoms of overactive bladder. Stimulation is delivered to the tibial nerve via a thin needle placed percutaneously for 30 min once a week for 12-weeks, and monthly thereafter. Studies have shown that this therapy can effectively relieve symptoms of overactive bladder; however, the frequent office visits present a barrier to patients and can impact therapy effectiveness. To mitigate the burden of frequent clinic visits, small implantable devices are being developed to deliver tibial neuromodulation. These devices are implanted during a single minimally invasive procedure and deliver stimulation intermittently, similar to percutaneous tibial neuromodulation. Here, we describe the implant procedure and design of a pivotal study evaluating the safety and effectiveness for an implantable tibial neuromodulation device. The Evaluation of Implantable Tibial Neuromodulation (TITAN 2) pivotal study is a prospective, multicenter, investigational device exemption study being conducted at up to 30 sites in the United States and enrolling subjects with symptoms of overactive bladder.

Background. One of the most crucial aspects of someone’s life is health. Therefore, individuals should be conscious about keeping themselves healthy by regular monitoring their health, which can be done with the help of modern medical technologies. Wearable medical devices using wearable sensors are the popular names of emerging technologies in the modern healthcare domain. Aim. This work presents the results of a systematic investigation of extensive research that has occurred for the last two decades in these research streams to provide a comprehensive mapping and temporal distribution of wireless medical device research. Methods. This study presents a relationship between the bibliographic items, their quality, and the quantity representing the most effective research topics on wearable medical devices. The analysis is performed using two useful parameters, namely a bibliometric network and a co-occurrence matrix. Data collection, data standardization, data mapping, and result analysis are the steps involved in the bibliometric analysis technique. In this study, VOSviewer software for bibliometric analysis is applied to the Scopus database. Results. By analysing bibliometric indicators from the Scopus database and using VOSviewer, we represent their distribution in countries, institutions, top researchers, and top journals. Furthermore, we analyse the co-citation of cited authors and the co-occurrence of keywords. The outcomes of the clustering and keyword analysis indicate that the research domain primarily focuses on the Internet of Things, machine learning, wearable sensors, mobile health, electrocardiogram, etc. Conclusions. Statistical investigation in association with the visual exploration presented in this article provides more substantial information than either of them used separately. In the future, this article can illuminate researchers and practitioners to develop a different theory to look at the factors that influence predictability in the research domain of wearable medical devices.

The COVID-19 crisis impacted emergency departments (ED) unexpectedly and exposed teams to major issues within a constantly changing environment. We implemented post-shift clinical debriefings (CDs) from the beginning of the crisis to cope with adaptability needs. As the crisis diminished, clinicians voiced a desire to maintain the post-shift CD program, but it had to be reshaped to succeed over the long term. A strategic committee, which included physician and nurse leadership and engaged front-line staff, designed and oversaw the implementation of CD. The CD structure was brief and followed a debriefing with a good judgment format. The aim of our program was to discover and integrate an organizational learning strategy to promote patient safety, clinicians' wellbeing, and engagement with the post-shift CD as the centerpiece. In this article, we describe how post-shift CD process was performed, lessons learned from its integration into our ED strategy to ensure value and sustainability and suggestions for adapting this process at other institutions. This novel application of debriefing was well received by staff and resulted in discovering multiple areas for improvement ranging from staff interpersonal interactions and team building to hospital wider quality improvement initiatives such as patient throughput.

Critically ill patients with rapidly deteriorating clinical status secondary to respiratory and cardio-vascular compromise are at risk for immediate collapse if the underlying pathology is not recognized and treated. Rapid diagnosis is of utmost importance regardless of the setting. Although there are data to support the use of point-of-care ultrasound in critical patients, there is no consensus about the best educational strategy to implement. We designed a curriculum based on the ABC (Airway, Breathing, Circulation) protocol that covers essential airway, lung, and cardiac ultrasound skills needed for fast diagnosis in critical patients and applied it in high-fidelity simulation-based medical education sessions for anesthesia and intensive care residents year one and two. After theoretical and practical assessments, our results show statistical differences in the theoretical knowledge and above-average results in practical assessment. Our proposed curriculum based on a simple ABC POCUS protocol, with an Airway, Breathing, and Circulation approach, is useful in teaching ultrasound basics regarding airway, lung, and cardiac examination using high-fidelity simulation training to anesthesia and intensive care residents, but further research is needed to establish the utility of Simulation-Based Medical Education in Point of Care Ultrasound in the critical patient.

This study aims to provide decision support for future measures to be taken regarding 2 tunnels using high-resolution 3D imaging of the subsurface. This project involves a more comprehensive risk analysis than localized tests, such as geotechnical surveys, and a more precise characterization of the subsoil at the tunnel entrance for approximately 200 meters. To address this issue, a 3D passive seismic tomography was conducted using a network installed on the surface of the study area and another in the tunnels to better analyze the subsurface beneath the tunnels. The 3D shear wave velocity model allowed the identification and delineation of risk zones and the estimation of risk levels based on the analysis of Vs (shear wave velocity) contrasts and their correlation with borehole data.

In the context of the construction of the new M3 Bordet-Albert metro line in Brussels, the new Tools Thielemans station will be built near the Gare du Midi. For this purpose, jet grouting work is planned at several sites. Hence, the control of the diameter of the jet grouting columns had to be done in parallel, in constrained conditions, such as, the geographical location in a historical building, the presence of 2m high cellars covering the area of interest, and the length of the columns (over 30 m). The only possible and most reliable methodologies were electric measurements in boreholes to image the reached diameter of the columns and cross-hole electric tomography for determining the electrical resistivities of the in-situ soils and identify heterogeneities in the medium for better parameterizing future jet grouting work.

Using the upGREAT instrument on board the Stratospheric Observatory for Infrared Astronomy, we imaged [C ii ] 157.74 and [O i ] 63.18 μ m line emission from a bright photodissociation region (PDR) associated with an ionized bubble located in the Nessie Nebula, a filamentary infrared dark cloud. A comparison with Australia Telescope Compact Array data reveals a classic photodissociation region (PDR) structure, with a uniform progression from ionized gas, to photodissociated gas, and to molecular gas from the bubble’s interior to its exterior. [O i ] line emission from the bubble’s PDR reveals self-absorption features. Toward a far-IR bright protostar, both [O i ] and [C ii ] show an absorption feature at a velocity of −18 km s ^−1 , the same velocity as an unrelated foreground molecular cloud. Since the gas density in typical molecular clouds is well below the [O i ] and [C ii ] critical densities, the excitation temperatures for both lines are low (∼20 K). The Meudon models demonstrate that the surface of a molecular cloud, externally illuminated by a standard G _0 = 1 interstellar radiation field, can produce absorption features in both transitions. Thus, the commonly observed [O i ] and [C ii ] self-absorption and absorption features plausibly arise from the subthermally excited, externally illuminated photodissociated envelopes of molecular clouds. The luminous young stellar object AGAL337.916-00.477, located precisely where the expanding bubble strikes the Nessie filament, is associated with two shock tracers: NH _3 (3,3) maser emission and SiO 2−1 emission, indicating an interaction between the bubble and the filament. The interaction of the expanding bubble with its parental dense filament has triggered star formation.

We use polarization data from SOFIA HAWC+ to investigate the interplay between magnetic fields and stellar feedback in altering gas dynamics within the high-mass star-forming region RCW 36, located in Vela C. This region is of particular interest as it has a bipolar H ii region powered by a massive star cluster, which may be impacting the surrounding magnetic field. To determine if this is the case, we apply the histogram of relative orientations (HRO) method to quantify the relative alignment between the inferred magnetic field and elongated structures observed in several data sets such as dust emission, column density, temperature, and spectral line intensity maps. The HRO results indicate a bimodal alignment trend, where structures observed with dense gas tracers show a statistically significant preference for perpendicular alignment relative to the magnetic field, while structures probed by the photodissociation region (PDR) tracers tend to align preferentially parallel relative to the magnetic field. Moreover, the dense gas and PDR associated structures are found to be kinematically distinct such that a bimodal alignment trend is also observed as a function of line-of-sight velocity. This suggests that the magnetic field may have been dynamically important and set a preferred direction of gas flow at the time that RCW 36 formed, resulting in a dense ridge developing perpendicular to the magnetic field. However, on filament scales near the PDR region, feedback may be energetically dominating the magnetic field, warping its geometry and the associated flux-frozen gas structures, causing the observed preference for parallel relative alignment.

Abstract Background Debriefing Assessment for Simulation in Healthcare (DASH©) is an instrument to assist in developing and evaluating debriefing skills. The objectives of this study were to translate the DASH from English to Portuguese and to conduct a cross-cultural adaptation of this translated instrument for Portugal and Brazil. Methods A forward translation of the DASH score sheets and Rater’s Handbook was accomplished and reviewed by authors from both Portuguese-speaking countries to reach the consensus harmonized version. A backward translation was reviewed by the original authors and discussed with the authors to produce the approved harmonized translation. This was then tested through a questionnaire to assess clarity, comprehensiveness, appropriateness, and cultural relevance among 10 simulation specialists from Portugal and Brazil. Results During the forward translation, 19 discrepancies were detected in the Portuguese DASH. After backward translation, 7 discrepancies were discussed and harmonized. All 10 simulation specialists from both countries reviewed the harmonized translation and made 70 suggestions, 64 of which were incorporated in the instrument after discussion among authors. Conclusions The translated DASH has undergone translation to Portuguese and a cross-cultural adaptation across Portugal and Brazil. It may be used to assess debriefings in healthcare settings in these countries.

We investigate the physical structure and conditions of photodissociation regions (PDRs) and molecular gas within the Pillars of Creation in the Eagle Nebula using SOFIA FEEDBACK observations of the [C ii ] 158 μ m line. These observations are velocity resolved to 0.5 km s ^−1 and are analyzed alongside a collection of complimentary data with similar spatial and spectral resolution: the [O i ] 63 μ m line, also observed with SOFIA, and rotational lines of CO, HCN, HCO ^+ , CS, and N _2 H ^+ . Using the superb spectral resolution of SOFIA, APEX, CARMA, and BIMA, we reveal the relationships between the warm PDR and cool molecular gas layers in context of the Pillars’ kinematic structure. We assemble a geometric picture of the Pillars and their surroundings informed by illumination patterns and kinematic relationships and derive physical conditions in the PDRs associated with the Pillars. We estimate an average molecular gas density ${n}_{{{\rm{H}}}_{2}}\sim 1.3\,\times \,{10}^{5}$ cm ^−3 and an average atomic gas density n _H ∼ 1.8 × 10 ^4 cm ^−3 and infer that the ionized, atomic, and molecular phases are in pressure equilibrium if the atomic gas is magnetically supported. We find pillar masses of 103, 78, 103, and 18 M _⊙ for P1a, P1b, P2, and P3, respectively, and evaporation times of ∼1–2 Myr. The dense clumps at the tops of the pillars are currently supported by the magnetic field. Our analysis suggests that ambipolar diffusion is rapid and these clumps are likely to collapse within their photoevaporation timescales.

Inflammation in COVID-19 produces intracellular iron overload with low circulating iron available for metabolic processes. The accumulated intracellular iron generates reactive species of oxygen and results in ferroptosis, a non-programmed cell death. Since no organ is spared, iron dysmetabolism increases the mortality and morbidity. Hepcidin and the mediator interleukin 6 are believed to play a role in the process. Our aim is to evaluate the predictive values of serologic iron and inflammatory parameters in COVID-19 critically ill patients. Hence, 24 patients were included. Hepcidin and interleukin 6, along with routine blood parameters, were determined and outcomes, such as death, multiple organ damage (MOD), anemia, and need for transfusions, were assessed. The results of this pilot study indicate that iron metabolism parameters individually, as well as models consisting of multiple laboratory and clinical variables, may predict the outcomes. Further larger studies are needed to validate the results of this pilot stud. However, this paper identifies a new direction for research.

Multiple‐input multiple‐output (MIMO) systems offer significant enhancements in terms of their data rate and channel capacity compared to traditional systems. However, correlation degrades the system performance and imposes practical limits on the number of antennas that can be incorporated into portable wireless devices. The use of switched parasitic antennas (SPAs) is a possible solution, especially where it is difficult to obtain sufficient signal decorrelation by conventional means. The covariance matrix represents the correlation present in the propagation channel, and has significant impact on the MIMO channel capacity. The results of this work demonstrate a significant improvement in the MIMO channel capacity by using SPA with the knowledge of the covariance matrix for all pattern configurations. By employing the “water‐pouring algorithm” to modify the covariance matrix, the channel capacity is significantly improved compared to traditional systems, which spread transmit power uniformly across all the antennas. A condition number is also proposed as a selection metric to select the optimal pattern configuration for MIMO‐SPAs.

We present a detailed overview of the science goals and predictions for the Prime-Cam direct-detection camera–spectrometer being constructed by the CCAT-prime collaboration for dedicated use on the Fred Young Submillimeter Telescope (FYST). The FYST is a wide-field, 6 m aperture submillimeter telescope being built (first light in late 2023) by an international consortium of institutions led by Cornell University and sited at more than 5600 m on Cerro Chajnantor in northern Chile. Prime-Cam is one of two instruments planned for FYST and will provide unprecedented spectroscopic and broadband measurement capabilities to address important astrophysical questions ranging from Big Bang cosmology through reionization and the formation of the first galaxies to star formation within our own Milky Way. Prime-Cam on the FYST will have a mapping speed that is over 10 times greater than existing and near-term facilities for high-redshift science and broadband polarimetric imaging at frequencies above 300 GHz. We describe details of the science program enabled by this system and our preliminary survey strategies.

Purpose: To evaluate the impact that the 2012 US Preventive Services Task Force (USPSTF) prostate-specific antigen (PSA) screening guidelines have had on the diagnosis of prostate cancer, we compared the incidence and distribution of new cases diagnosed in 2011-before the USPSTF PSA screening recommendations versus 2014 at which time the guidelines were widely adopted. Materials and Methods: We identified all prostate biopsies performed by a large urology group practice utilizing a centralized pathology lab. We examined total biopsies performed, percentage of positive biopsies, and for those with positive biopsies examined for differences in patient age, PSA, and Gleason score. Results: A total of 4,178 biopsies were identified – 2,513 in 2011 and 1,665 in 2014. The percentage of positive biopsies was 27% in 2011 versus 34% in 2014 (p

Rationale: Nasopharyngeal administration of live virulence-attenuated Streptococcus pneumoniae strains is a potential novel preventative strategy. One target for creating reduced virulence S. pneumoniae strains is the capsule, but loss of the capsule reduces the duration of S. pneumoniae colonisation in mice which could impair protective efficacy against subsequent infection. Objectives: To assess protective efficacy of nasopharyngeal administration of unencapsulated S. pneumoniae strains in murine infection models. Methods: Strains containing cps locus deletions combined with the S. pneumoniae virulence factors psaA (reduces colonisation) or proABC (no effect on colonisation) were constructed and their virulence phenotypes and ability to prevent recolonisation or invasive infection assessed using mouse infection models. Serological responses to colonisation were compared between strains using ELISAs, immunoblots and 254 S. pneumoniae protein antigen array. Measurements and Main Results: The ∆cps/piaA and ∆cps/proABC strains were strongly attenuated in virulence in both invasive infection models and had a reduced ability to colonise the nasopharynx. ELISAs, immunoblots and protein arrays showed colonisation with either strain stimulated weaker serological responses than the wild type strain. Mice previously colonised with these strains were protected against septicaemic pneumonia but, unlike mice colonised with the wild type strain, not against S. pneumoniae recolonisation. Conclusions: Colonisation with the ∆cps/piaA and ∆cps/proABC strains prevented subsequent septicaemia, but in contrast, to published data for encapsulated double mutant strains they did not prevent recolonisation with S. pneumoniae. These data suggest targeting the cps locus is a less effective option for creating live attenuated strains that prevent S. pneumoniae infections.

Purpose: To describe the correlation between clinically measured hyomental distance ratio (HMDRclin) and the ultrasound measurement (HMDRecho) in patients with and without morbid obesity and to compare their diagnostic accuracy for difficult airway prediction. Methods: HMDRclin and HMDRecho were recorded the day before surgery in 160 consecutive consenting patients. Laryngoscopy was performed by a skilled anesthesiologist, with grades III and IV Cormack−Lehane being considered difficult views of the glottis. Linear regression was used to assess the correlation between HMDRclin and HDMRecho and receiver operating curve analysis was used to compare the performance of the two for predicting difficult airway. Results: The linear correlation between HMDRclin and HDMRecho in patients without morbid obesity had a Pearson coefficient of 0.494, while for patients with morbid obesity this was 0.14. A slightly higher area under the curve for HMDRecho was oberved: 0.64 (5%CI 0.56−0.71) versus 0.52 (95%CI, 0.44−0.60) (p = 0.34). Conclusion: The association between HMDRclin and HDMRecho is moderate in patients without morbid obesity, but negligible in morbidly obese patients. These might be explained by difficulties in palpating anatomical structures of the airway.

Students are the future of a nation. Personalizing student interests in higher education courses is one of the biggest challenges in higher education. Various AI and ML approaches have been used to study student behaviour. Existing AI and ML algorithms are used to identify features for various fields, such as behavioural analysis, economic analysis, image processing, and personalized medicine. However, there are major concerns about the interpretability and understandability of the decision made by a model. This is because most AI algorithms are black-box models. In this study, explain- able AI (XAI) aims to break the black box nature of an algorithm. In this study, XAI is used to identify engineering students' interests, and BRB and SP-LIME are used to explain which attributes are critical to their studies. We also used (PCA) for feature selection to identify the student cohort. Clustering the cohort helps to analyse the between influential features in terms of engineering discipline selection. The results show that there are some valuable factors that influence their study and, ultimately, the future of a nation.

A case of human melioidosis caused by a novel sequence type of Burkholderia pseudomallei occurred in a child in Malawi, southern Africa. A literature review showed that human cases reported from the continent have been increasing.

Congenital Pulmonary Airway Malformations (CPAMs) are abnormalities of lung parenchyma that are often diagnosed upon prenatal imaging as opposed to postnatal symptoms. With a clinical presentation identical to CPAMs, Pleuropulmonary Blastoma (PPB) is a rare pulmonary neoplasm of highly malignant potential. We present a rare case of a female infant with a vague medical history of respiratory distress syndrome (RDS) at birth, presenting with a tension pneumothorax at three months of age, thought initially to be secondary to CPAM, but found to be PPB upon surgical resection and histological analysis. PPB is a rare pulmonary neoplasm of childhood that originates from the primitive interstitium of the lung, resulting in lesions that can be highly malignant. It is classified as type I (cystic), type II (cystic/solid) or type III (solid), with a progression of disease and worsening prognosis from type I to type III. Due to the cystic nature of CPAM and PPB it is difficult to differentiate on imaging alone; diagnosis must be made based on histological analysis. The highly malignant nature and potential for morbidity and mortality of PPB should make clinicians consider early resection of cystic lung lesions preferentially on an elective basis.

Discovery of a pelvis attributed to the Late Jurassic armor-plated dinosaur Gargoyleosaurus sheds new light on the origin of the peculiar non-vertical, broad, flaring pelvis of ankylosaurs. It further substantiates separation of the two ankylosaurs from the Morrison Formation of the western United States, Gargoyleosaurus and Mymoorapelta. Although horizontally oriented and lacking the medial curve of the preacetabular process seen in Mymoorapelta, the new ilium shows little of the lateral flaring seen in the pelvis of Cretaceous ankylosaurs. Comparison with the basal thyreophoran Scelidosaurus demonstrates that the ilium in ankylosaurs did not develop entirely by lateral rotation as is commonly believed. Rather, the preacetabular process rotated medially and ventrally and the postacetabular process rotated in opposition, i.e., lateral and ventrally. Thus, the dorsal surfaces of the preacetabular and postacetabular processes are not homologous. In contrast, a series of juvenile Stegosaurus ilia show that the postacetabular process rotated dorsally ontogenetically. Thus, the pelvis of the two major types of Thyreophora most likely developed independently. Examination of other ornithischians show that a non-vertical ilium had developed independently in several different lineages, including ceratopsids, pachycephalosaurs, and iguanodonts. Therefore, a separate origin for the non-vertical ilium in stegosaurs and ankylosaurs does have precedent.