The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) collects detailed clinical data from participating hospitals using standardized data definitions, analyzes ...these data, and provides participating hospitals with reports that permit risk-adjusted comparisons with a surgical quality standard. Since its inception, the ACS NSQIP has worked to refine surgical outcomes measurements and enhance statistical methods to improve the reliability and validity of this hospital profiling. From an original focus on controlling for between-hospital differences in patient risk factors with logistic regression, ACS NSQIP has added a variable to better adjust for the complexity and risk profile of surgical procedures (procedure mix adjustment) and stabilized estimates derived from small samples by using a hierarchical model with shrinkage adjustment. New models have been developed focusing on specific surgical procedures (eg, “Procedure Targeted” models), which provide opportunities to incorporate indication and other procedure-specific variables and outcomes to improve risk adjustment. In addition, comparative benchmark reports given to participating hospitals have been expanded considerably to allow more detailed evaluations of performance. Finally, procedures have been developed to estimate surgical risk for individual patients. This article describes the development of, and justification for, these new statistical methods and reporting strategies in ACS NSQIP.
Empirical studies, often in the form of controlled experiments, have been widely adopted in software engineering research as a way to evaluate the merits of new software engineering tools. However, ...controlled experiments involving
human participants
actually
using
new tools are still rare, and when they are conducted, some have serious validity concerns. Recent research has also shown that many software engineering researchers view this form of tool evaluation as too risky and too difficult to conduct, as they might ultimately lead to inconclusive or negative results. In this paper, we aim both to help researchers minimize the risks of this form of tool evaluation, and to increase their quality, by offering practical methodological guidance on designing and running controlled experiments with developers. Our guidance fills gaps in the empirical literature by explaining, from a practical perspective, options in the recruitment and selection of human participants, informed consent, experimental procedures, demographic measurements, group assignment, training, the selecting and design of tasks, the measurement of common outcome variables such as success and time on task, and study debriefing. Throughout, we situate this guidance in the results of a new systematic review of the tool evaluations that were published in over 1,700 software engineering papers published from 2001 to 2011.
In a cell-free approach to regenerative therapeutics, transient application of paracrine factors in vivo could be used to alter the behavior and fate of progenitor cells to achieve sustained clinical ...benefits. Here we show that intramyocardial injection of synthetic modified RNA (modRNA) encoding human vascular endothelial growth factor-A (VEGF-A) results in the expansion and directed differentiation of endogenous heart progenitors in a mouse myocardial infarction model. VEGF-A modRNA markedly improved heart function and enhanced long-term survival of recipients. This improvement was in part due to mobilization of epicardial progenitor cells and redirection of their differentiation toward cardiovascular cell types. Direct in vivo comparison with DNA vectors and temporal control with VEGF inhibitors revealed the greatly increased efficacy of pulse-like delivery of VEGF-A. Our results suggest that modRNA is a versatile approach for expressing paracrine factors as cell fate switches to control progenitor cell fate and thereby enhance long-term organ repair.
Whether SARS-CoV-2 infection and COVID-19 vaccines confer exposure-dependent ("leaky") protection against infection remains unknown. We examined the effect of prior infection, vaccination, and hybrid ...immunity on infection risk among residents of Connecticut correctional facilities during periods of predominant Omicron and Delta transmission. Residents with cell, cellblock, and no documented exposure to SARS-CoV-2 infected residents were matched by facility and date. During the Omicron period, prior infection, vaccination, and hybrid immunity reduced the infection risk of residents without a documented exposure (HR: 0.36 0.25-0.54; 0.57 0.42-0.78; 0.24 0.15-0.39; respectively) and with cellblock exposures (0.61 0.49-0.75; 0.69 0.58-0.83; 0.41 0.31-0.55; respectively) but not with cell exposures (0.89 0.58-1.35; 0.96 0.64-1.46; 0.80 0.46-1.39; respectively). Associations were similar during the Delta period and when analyses were restricted to tested residents. Although associations may not have been thoroughly adjusted due to dataset limitations, the findings suggest that prior infection and vaccination may be leaky, highlighting the potential benefits of pairing vaccination with non-pharmaceutical interventions in crowded settings.
Background and Context: Current introductory instruction fails to identify, structure, and sequence the many skills involved in programming.
Objective: We proposed a theory which identifies four ...distinct skills that novices learn incrementally. These skills are tracing, writing syntax, comprehending templates (reusable abstractions of programming knowledge), and writing code with templates. We theorized that explicit instruction of these skills decreases cognitive demand.
Method: We conducted an exploratory mixed-methods study and compared students' exercise completion rates, error rates, ability to explain code, and engagement when learning to program. We compared material that reflects this theory to more traditional material that does not distinguish between skills.
Findings: Teaching skills incrementally resulted in improved completion rate on practice exercises, and decreased error rate and improved understanding of the post-test.
Implications: By structuring programming skills such that they can be taught explicitly and incrementally, we can inform instructional design and improve future research on understanding how novice programmers develop understanding.
Explicit programming strategies LaToza, Thomas D.; Arab, Maryam; Loksa, Dastyni ...
Empirical software engineering : an international journal,
07/2020, Letnik:
25, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Software developers solve a diverse and wide range of problems. While software engineering research often focuses on tools to support this problem solving, the strategies that developers use to solve ...problems are at least as important. In this paper, we offer a novel approach for enabling developers to follow explicit programming strategies that describe how an expert tackles a common programming problem. We define explicit programming strategies, grounding our definition in prior work both within software engineering and in other professions which have adopted more explicit procedures for problem solving. We then present a novel notation called Roboto and a novel strategy tracker tool that explicitly represent programming strategies and frame executing strategies as a collaborative effort between human abilities to make decisions and computer abilities to structure process and persist information. In a formative evaluation, 28 software developers of varying expertise completed a design task and a debugging task. We found that, compared to developers who are free to choose their own strategies, developers given explicit strategies experienced their work as more organized, systematic, and predictable, but also more constrained. Developers using explicit strategies were objectively more successful at the design and debugging tasks. We discuss the implications of Roboto and these findings, envisioning a thriving ecosystem of explicit strategies that accelerate and improve developers’ programming problem solving.
The Centers for Disease Control and Prevention recommends serial rapid antigen assay collection within congregate facilities. Although modeling and observational studies from communities and ...long-term care facilities have shown serial collection provides adequate sensitivity and specificity, the accuracy within correctional facilities remains unknown.
Using Connecticut Department of Correction data from 21 November 2020 to 15 June 2021, we estimated the accuracy of a rapid assay, BinaxNOW (Abbott), under 3 collection strategies: single test collection and serial collection of 2 and 3 tests separated by 1-4 days. The sensitivity and specificity of the first (including single), second, and third serially collected BinaxNOW tests were estimated relative to RT-PCRs collected ≤1 day of the BinaxNOW test. The accuracy metrics of the testing strategies were then estimated as the sum (sensitivity) and product (specificity) of tests in each strategy.
Of the 13 112 residents who contributed ≥1 BinaxNOW test during the study period, 3825 contributed ≥1 RT-PCR paired BinaxNOW test. In relation to RT-PCR, the 3-rapid-antigen-test strategy had a sensitivity of 95.9% (95% CI: 93.6-97.5%) and specificity of 98.3% (95% CI: 96.7-99.1%). The sensitivities of the 2- and 1-rapid-antigen-test strategies were 88.8% and 66.8%, and the specificities were 98.5% and 99.4%, respectively. The sensitivity was higher among symptomatic residents and when RT-PCRs were collected before BinaxNOW tests.
We found serial antigen test collection resulted in high diagnostic accuracy. These findings support serial collection for outbreak investigation, screening, and when rapid detection is required (such as intakes or transfers).
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), in operation since late 2004, evaluates surgical quality and safety by feeding back valid, timely, ...risk-adjusted outcomes, which providers use to improve care.
A number of components have been developed and refined in the more than a decade since ACS NSQIP's initiation. These items can be grouped into areas of data collection, case sampling, risk adjustment, feedback reporting, the expansion into procedure-targeted sampling, development of improvement collaboratives, and the development of improvement tools. Although ACS NSQIP was originally designed as a hospital-based program, it now also allows for surgeon-specific reporting that can be used by individual surgeons as a feedback tool to improve their performance.
There are more than 600 ACS NSQIP hospitals in 49 of the 50 states of the United States and in 13 other countries. Virtually all surgical (sub)specialties are touched by ACS NSQIP, which contains several million patient records and more than 100 statistically risk-adjusted models. In studies that have used ACS NSQIP clinical data, demonstrable improvement has been reported in local hospitals, in regional collaboratives, and across the program overall. Concomitantly, substantial cost savings for individual hospitals, as well as at regional and national levels, have been reported.
ACS NSQIP has not only demonstrated how and why the use of accurate clinical data is crucial, but also how the program, through its risk-adjusted feedback, improvement tools, and hospital collaboratives, helps hospitals and providers to achieve safer surgery and better patient care.
Post-secondary Computer Science (CS) students' career choices are complex sociocultural decisions, shaped by self-efficacy, belonging, and a multitude of known factors. Prior work has investigated ...the effect of these factors on career choice, but perspectives that examine norms of career practice are unexplored within computing.
This work applies Field Theory to surface the norms of career practice within a CS department, the mechanisms used to reinforce these norms, and students' experience of these norms.
We conducted semi-structured interviews of 18 students, graduates, academic advisors and senior faculty program leaders within one CS department, analyzing data with a Bourdieusian lens.
In line with prior work, we found that normative career practice centered prestige, leading students to prioritize work at elite technology companies. This work contributes three mechanisms of norm enforcement: companies utilized their departmental position to recruit more effectively, curricula optimized preparing students for prestigious work, and career advising assumed alignment with departmental norms. Students aligned with departmental norms opted for prestige to alleviate career uncertainty and because more fulfilling work felt inaccessible; students unaligned with departmental norms felt conflicted about their participation within CS and substantial effort was required to resist norms.
Normative CS career practice likely discourages students who lack alignment with norms from participating in CS; additionally, the narrowness of established norms leaves little space for alternatives. Broadening participation efforts in CS are unlikely to be successful without structurally broadening what constitutes legitimate career practice to make space for students' diverseaspirations.
Previous research has documented the fragmented nature of software development work. To explain this in more detail, we analyzed software developers' day-to-day information needs. We observed ...seventeen developers at a large software company and transcribed their activities in 90-minute sessions. We analyzed these logs for the information that developers sought, the sources that they used, and the situations that prevented information from being acquired. We identified twenty-one information types and cataloged the outcome and source when each type of information was sought. The most frequently sought information included awareness about artifacts and coworkers. The most often deferred searches included knowledge about design and program behavior, such as why code was written a particular way, what a program was supposed to do, and the cause of a program state. Developers often had to defer tasks because the only source of knowledge was unavailable coworkers.
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