Recognizing and attempting management of patients with urgent or emergent conditions is one of the Association of American Medical Colleges Core Entrustable Professional Activities (#10) and a skill ...desired of new interns. However, given the acuity of these patient conditions, medical students often struggle to gain experience in these situations. Virtual reality could help fill this void while lowering costs and resources compared with high-fidelity simulation.
We converted a high-fidelity chest pain simulation case to virtual reality format utilizing short video clips filmed with a 360-degree camera and superimposed menus of options at decision points. This virtual reality simulation was offered to fourth-year medical students during their transition to residency course in the spring of 2023. Students were offered a post-survey on the simulation.
There were 47 fourth-year students that completed the virtual reality simulation; 41 completed the post-survey (response rate 87.2%). Over 90% of the students agreed or strongly agreed with the following statements: the virtual reality simulation was a valuable part of the transition to residency course, the virtual reality case was similar to what they will face as an intern, and they would like to have more virtual reality simulations earlier in the fourth year; 85.4% agreed or strongly agreed that the virtual reality simulation helped prepare them for the first few days of intern year.
We demonstrated that virtual reality is an acceptable, cost-effective, and feasible modality to teach medical students how to recognize and attempt management of urgent clinical situations (Core Entrustable Professional Activity 10).
Composites of direct-spun carbon nanotube (CNT) mats and epoxy are manufactured and tested in order to determine their mechanical and electrical properties. The mats are spun directly from a floating ...catalyst, chemical vapour deposition reactor. The volume fraction of epoxy is varied widely by suitable dilution of the epoxy resin with acetone. Subsequent evaporation of the acetone, followed by a cure cycle, leads to composites of varying volume fraction of CNT, epoxy and air. The modulus, strength, electrical conductivity and piezoresistivity of the composites are measured. The CNT mats and their composites exhibit an elastic-plastic stress-strain response under uniaxial tensile loading, and the degree of anisotropy is assessed by testing specimens in 0°, 45° and 90° directions with respect to the draw direction of mat manufacture. The electrical conductivity scales linearly with CNT volume fraction, irrespective of epoxy volume fraction. In contrast, the modulus and strength depend upon both CNT and epoxy volume fractions in a non-linear manner. The macroscopic moduli of the CNT mat-epoxy composites are far below the Voigt bound based on the modulus of CNT walls and epoxy. A micromechanical model is proposed to relate the macroscopic modulus and yield strength of a CNT mat-epoxy composite to the microstructure.
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Objectives: Social engagement has been linked to preserved cognitive functioning in later life. While social engagement is often operationalized as social network size, social networks can vary not ...only in size, but also in composition. Previous work has found that having a greater proportion of family in a network is associated with worse socioemotional and cognitive outcomes compared to having a greater proportion of friends. In addition, social resources may differentially affect cognition in minority groups at higher risk of cognitive impairment. Therefore, the current study aimed to examine racial/ethnic differences in the relationship between network characteristics and cognition. Method: Ethnically and racially diverse older adults from the Washington Heights-Inwood Columbia Aging Project (n = 548, 60-93 years) were used. Multiple regressions were conducted to examine the effects of ethnicity/race, size, composition, and their interaction on global cognition. Results: Analyses revealed that networks with a greater proportion of friends were associated with better global cognition than networks with a greater proportion of family. Additionally, larger social network size was only associated with better global cognition among individuals who had a greater proportion of friends in their networks. Race further moderated this effect, as it was limited to African Americans. Discussion: Overall, these findings highlight the importance of looking at both composition and size when examining the relationship between social network characteristics and global cognition. These findings suggest that friendships may be especially important and further suggest that social network characteristics and cognitive aging may be more strongly related among African Americans.
General Scientific Summary
The current study's findings suggest that social network characteristics may be a potentially relevant and modifiable social resource for reducing racial disparities in cognitive aging. These findings specifically emphasize that friendships may be particularly important for maintaining cognitive functioning for African American older adults.
Abstract
BACKGROUND
Over the last 2 decades, advances in systemic therapy have increased the expected overall survival for patients with cancer. It is unclear whether the same survival benefit has ...been conferred to patients requiring surgery for metastatic spinal disease.
OBJECTIVE
To examine trends in postoperative survival over a 20-yr period for patients surgically treated for spinal metastatic disease.
METHODS
Data were obtained for 1515 patients who underwent surgery for metastatic epidural spinal cord compression or tumor-related mechanical instability. Postoperative overall survival was calculated for all included patients using Kaplan-Meier methodology from date of surgery until death or last follow-up for those who were censored. Trends were analyzed using Cox proportional hazards modeling.
RESULTS
Patients with renal, breast, lung, and colon cancers experienced a statistically significant improvement in survival over time based on the year of surgery (40%-100% improvement over the study period), whereas the overall survival trend for the entire cohort did not reach statistical significance (P = .12, median survival 0.71 yr, 95% CI 0.63-0.78). Patients presenting with synchronous metastatic disease had better survival compared to those presenting with metachronous disease (median overall survival: 0.94 vs 0.63 yr, respectively; log-rank P-value = .00001).
CONCLUSION
The postoperative survival among patients with spinal metastases has improved over the past 20 yr, particularly in patients with kidney, breast, lung, and colon tumors metastatic to the spine. The observed survival improvement emphasizes the need for long-term outcome consideration in treatment decisions for patients undergoing surgery for spinal metastatic tumors.
Since the release of ChatGPT, numerous positive applications for this artificial intelligence (AI) tool in higher education have emerged. Faculty can reduce workload by implementing the use of AI. ...While course evaluations are a common tool used across higher education, the process of identifying useful information from multiple open-ended comments is often time consuming. The purpose of this study was to explore the use of ChatGPT in analyzing course evaluation comments, including the time required to generate themes and the level of agreement between instructor-identified and AI-identified themes.
Course instructors independently analyzed open-ended student course evaluation comments. Five prompts were provided to guide the coding process. Instructors were asked to note the time required to complete the analysis, the general process they used, and how they felt during their analysis. Student comments were also analyzed through two independent Open-AI ChatGPT user accounts. Thematic analysis was used to analyze the themes generated by instructors and ChatGPT. Percent agreement between the instructor and ChatGPT themes were calculated for each prompt, along with an overall agreement statistic between the instructor and two ChatGPT themes.
There was high agreement between the instructor and ChatGPT results. The highest agreement was for course-related topics (range 0.71-0.82) and lowest agreement was for weaknesses of the course (range 0.53-0.81). For all prompts except themes related to student experience, the two ChatGPT accounts demonstrated higher agreement with one another than with the instructors. On average, instructors took 27.50 ± 15.00 min to analyze their data (range 20-50). The ChatGPT users took 10.50 ± 1.00 min (range 10-12) and 12.50 ± 2.89 min (range 10-15) to analyze the data. In relation to reviewing and analyzing their own open-ended course evaluations, instructors reported feeling anxiety prior to the process, satisfaction during the process, and frustration related to findings.
This study offers valuable insights into the potential of ChatGPT as a tool for analyzing open-ended student course evaluation comments in health professions education. However, it is crucial to ensure ChatGPT is used as a tool to assist with the analysis and to avoid relying solely on its outputs for conclusions.
Single particle levitation techniques allow us to probe samples in a contactless way, negating the effect that surfaces could have on processes such as crystallisation and phase transitions. ...Small-angle X-ray scattering (SAXS) is a common method characterising the nanoscale order in aggregates such as colloidal, crystalline and liquid crystalline systems. Here, we present a laboratory-based small-angle X-ray scattering (SAXS) setup combined with acoustic levitation. The capability of this technique is highlighted and compared with synchrotron-based levitation-SAXS and X-ray diffraction. We were able to follow the deliquescence and crystallisation of sucrose, a commonly used compound for the study of viscous atmospheric aerosols. The observed increased rate of the deliquescence-crystallisation transitions on repeated cycling could suggest the formation of a glassy sucrose phase. We also followed a reversible phase transition in an oleic acid-based lyotropic liquid crystal system under controlled humidity changes. Our results demonstrate that the coupling of acoustic levitation with an offline SAXS instrument is feasible, and that the time resolution and data quality are sufficient to draw physically meaningful conclusions. There is a wide range of potential applications including topics such as atmospheric aerosol chemistry, materials science, crystallisation and aerosol spray drying.
Single particle levitation techniques allow us to probe samples in a contactless way, negating the effect that surfaces could have on processes such as crystallisation and phase transitions.
The recurrence score based on the 21-gene breast cancer assay predicts chemotherapy benefit if it is high and a low risk of recurrence in the absence of chemotherapy if it is low; however, there is ...uncertainty about the benefit of chemotherapy for most patients, who have a midrange score.
We performed a prospective trial involving 10,273 women with hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, axillary node-negative breast cancer. Of the 9719 eligible patients with follow-up information, 6711 (69%) had a midrange recurrence score of 11 to 25 and were randomly assigned to receive either chemoendocrine therapy or endocrine therapy alone. The trial was designed to show noninferiority of endocrine therapy alone for invasive disease-free survival (defined as freedom from invasive disease recurrence, second primary cancer, or death).
Endocrine therapy was noninferior to chemoendocrine therapy in the analysis of invasive disease-free survival (hazard ratio for invasive disease recurrence, second primary cancer, or death endocrine vs. chemoendocrine therapy, 1.08; 95% confidence interval, 0.94 to 1.24; P=0.26). At 9 years, the two treatment groups had similar rates of invasive disease-free survival (83.3% in the endocrine-therapy group and 84.3% in the chemoendocrine-therapy group), freedom from disease recurrence at a distant site (94.5% and 95.0%) or at a distant or local-regional site (92.2% and 92.9%), and overall survival (93.9% and 93.8%). The chemotherapy benefit for invasive disease-free survival varied with the combination of recurrence score and age (P=0.004), with some benefit of chemotherapy found in women 50 years of age or younger with a recurrence score of 16 to 25.
Adjuvant endocrine therapy and chemoendocrine therapy had similar efficacy in women with hormone-receptor-positive, HER2-negative, axillary node-negative breast cancer who had a midrange 21-gene recurrence score, although some benefit of chemotherapy was found in some women 50 years of age or younger. (Funded by the National Cancer Institute and others; TAILORx ClinicalTrials.gov number, NCT00310180 .).
Recent advances in mobile technology have allowed individuals to engage in sexting (i.e., sharing sexual words and images via technology). Researchers have examined the prevalence and correlates of ...sexting, but differences in samples and definitions make it difficult to develop a cohesive picture of adult sexting. This study extends our understanding of sexting behavior by using binationally-representative data from 615 Americans and Canadians in committed heterosexual and same-sex couple relationships from The Couple Well-Being Project. Using latent profile analysis, we explored how individuals' patterns of sending and receiving explicit word and/or picture text messages illustrated distinct profiles of sexting behavior. The analyses revealed 4 distinct groups of sexters: non-sexters (71.5%), word-only sexters (14.5%), frequent sexters (8.5%), and hyper sexters (5.5%). We then compared these groups on various relationship factors, indicators of individual well-being, and technology-related behaviors. Frequent and hyper sexters reported greater sexual satisfaction but were not significantly different from non-sexters or word-only sexters in relationship satisfaction. Further, frequent and hyper sexters scored more poorly on other relationship variables (i.e., attachment security, commitment, ambivalence, and conflict) than non-sexters or word-only sexters and showed greater media and pornography viewing, technoference in face-to-face interactions with their partner, and infidelity-related behaviors on social media.
•There were 4 types of sexters: non-sexters, word-only, frequent, and hyper sexters.•Non-sexters were the most prevalent type of sexter (71.5%).•Sexters scored higher in sexual satisfaction.•Sexters were no different in overall relationship satisfaction.•Frequent and hyper sexters scored more poorly on other relationship variables.
: media-1vid110.1542/5799875103001PEDS-VA_2017-3616
OBJECTIVES: Noncigarette tobacco products may confer a risk of marijuana use similar to combustible cigarettes. We examined whether adolescent ...electronic cigarette (e-cigarette), hookah, or combustible cigarette use is associated with initiating and currently using marijuana as well as using both tobacco and marijuana concurrently.
Adolescents from 10 public schools in Los Angeles, California, completed in-classroom surveys at baseline (fall 2013, ninth grade) and at a 24-month follow-up (fall 2015, 11th grade). Among adolescents who never used marijuana at baseline (
= 2668), associations of baseline e-cigarette, hookah, or combustible cigarette use with ever marijuana use (initiation), current marijuana use (past 30 days), and current dual use of marijuana and these tobacco products at the 24-month follow-up were examined.
Baseline ever versus never e-cigarette use was associated with initiation (odds ratio OR 3.63; 95% confidence interval CI 2.69-4.90) and current (OR 3.67; 95% CI 2.51-5.36) marijuana use 24 months later. Ever versus never hookah use was associated with initiation (OR 3.55; 95% CI 2.49-5.08) and current (OR 4.10; 95% CI 2.69-6.25) marijuana use 24 months later. Similar associations were observed for combustible cigarette smoking and initiation (OR 4.30; 95% CI 2.79-6.63) and current use of marijuana (OR 1.97; 95% CI 1.05-3.68). Current use of any of these tobacco products at baseline was associated with current use of both tobacco and marijuana (OR 2.28; 95% CI 1.47-3.55) 24 months later.
The association between tobacco use and subsequent marijuana use across adolescence extends to multiple tobacco products.
High-resolution climatic data are essential to many questions and applications in environmental research and ecology. Here we develop and implement a new semi-mechanistic downscaling approach for ...daily precipitation estimate that incorporates high resolution (30 arcsec, ≈1 km) satellite-derived cloud frequency. The downscaling algorithm incorporates orographic predictors such as wind fields, valley exposition, and boundary layer height, with a subsequent bias correction. We apply the method to the ERA5 precipitation archive and MODIS monthly cloud cover frequency to develop a daily gridded precipitation time series in 1 km resolution for the years 2003 onward. Comparison of the predictions with existing gridded products and station data from the Global Historical Climate Network indicates an improvement in the spatio-temporal performance of the downscaled data in predicting precipitation. Regional scrutiny of the cloud cover correction from the continental United States further indicates that CHELSA-EarthEnv performs well in comparison to other precipitation products. The CHELSA-EarthEnv daily precipitation product improves the temporal accuracy compared with a large improvement in the spatial accuracy especially in complex terrain.
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