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Published: 25 July 2024
Last updated: 26 July 2024

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1

Keating, Xiaofen Deng, Prithwi Raj Subramaniam, Rulan Shangguan, and Li Chen. "Physical Education Program Changes from 2006 to 2010." Journal of Teaching in Physical Education 32, no. 2 (April 2013): 205–13. http://dx.doi.org/10.1123/jtpe.32.2.205.

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This study aimed to examine changes in physical education (PE) programs nation-wide from 2006 to 2010 by analyzing the data reported in the Shape of the Nation published by the National Association for Sport and Physical Education. Means and standard deviations for numeric variables in the reports were computed. For categorical variables, percentages were calculated. Data were analyzed using the Wilcoxon test. The data from this study indicate a significant change in elementary PE as more states have mandated elementary PE and licensed elementary PE teachers. Significant increases in required PE units for high school graduation were also noted, indicating a positive change toward enhancing high school PE. However, the percentages of states with funding for professional development and required PE coordinator decreased significantly, suggesting that more work needs to be done if school PE is to provide the help and support requested by public health agencies.
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2

Darnell, Julia, Mimi Lou, and Lisa Goldstone. "Change in pharmacy resident familiarity, attitudes, comfort, and knowledge regarding digital health." Pharmacy Education 23, no. 1 (August 4, 2023): 362–67. http://dx.doi.org/10.46542/pe.2023.231.362367.

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Background: Digital health is a growing area of interest in healthcare however. There is limited evidence to support this topic is being covered in pharmacy education, including postgraduate residency training programmes. This study aimed to determine if exposure to digital health topics throughout a teaching certificate programme leads to a significant change in resident familiarity, attitudes, comfort, and knowledge regarding digital health. Methods: The resident cohort was exposed to digital health content during a teaching certificate. Residents completed a questionnaire regarding their familiarity, attitudes, comfort, and knowledge regarding digital health at the beginning and end of the teaching certificate. Responses to each section of the questionnaire, as well as an overall score, were calculated and analysed. Results: Eighteen residents completed both the pre-and post-questionnaire. The median scores for familiarity and comfort increased significantly (p < 0.0001) after the yearlong intervention. Median scores for attitudes and knowledge did not see a significant change after intervention. Conclusion: After exposure to digital health in a teaching certificate programme, pharmacy residents demonstrated a significant increase in familiarity and comfort with digital health, however there was not a significant change in attitudes or knowledge.
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Vigoderis, Ricardo Brauer, Glaudemir Santos Leite, Tamara de Lima Oliveira, João Manoel Da Silva, Eusileide Suianne Rodrigues Lopes De Melo, Aristóteles Junio de Santana Santos, Josimar Vieira Dos Reis, and Gerla Castello Branco Chinelate. "Impacto da implantação de um empreendimento imobiliário em Garanhuns-PE." CONTRIBUCIONES A LAS CIENCIAS SOCIALES 16, no. 7 (July 3, 2023): 5402–18. http://dx.doi.org/10.55905/revconv.16n.7-013.

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Objetivou-se por esse estudo analisar alguns impactos da implantação um empreendimento imobiliário voltado para os contemplados no Programa Minha Casa Minha Vida e com isso fazer uma reflexão para projetos futuros. O trabalho foi desenvolvido no município de Garanhuns, que está situado na região Nordeste do Brasil, no Agreste Meridional de Pernambuco, entre as latitudes 08º 53’ 25’’S e longitude 36º 29’ 34’’O, englobando uma área total de 458.552 km². Objetivando verificar a evolução do Residencial Antônio Cordeiro e dos seus impactos na cobertura vegetal foi realizada uma análise multitemporal do NDVI da área de estudo. Para tal foram coletados dados da banda espectral do vermelho e infravermelho próximo dos satélites Landsat 5 (28/10/2009) e Landsat 8 (30/11/2015, 08/12/2018 e 10/10/2020) a partir do portal Earth Explorer mantido pela instituição científica Serviço Geológico dos Estados Unidos. Utilizando a ferramenta raster calculator do software ArcGIS os dados foram aplicados na referida e equação para obtenção do NDVI da área de estudo. Nas condições em que o trabalho foi desenvolvido, foi possível concluir que são indiscutíveis os impactos que o empreendimento causou na área, incluindo a substituição da cobertura e a impermeabilização de uma extensa área, alterando o regime de escoamento. Desta forma, é necessária uma reflexão com relação à empreendimentos futuros, para que estejam mais comprometidos com a sustentabilidade.
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Mclaughlin, Matthew, Jed Duff, Tom McKenzie, Elizabeth Campbell, Rachel Sutherland, John Wiggers, and Luke Wolfenden. "Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study." JMIR Pediatrics and Parenting 4, no. 3 (July 26, 2021): e26690. http://dx.doi.org/10.2196/26690.

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Background Effectively scaled-up physical activity interventions are urgently needed to address the high prevalence of physical inactivity. To facilitate scale-up of an efficacious school-based physical activity program (Physical Activity 4 Everyone [PA4E1]), provision of implementation support to physical education (PE) teachers was adapted from face-to-face and paper-based delivery modes to partial delivery via a website. A lack of engagement (usage and subjective experience) with digital delivery modes, including websites, may in part explain the typical reduction in effectiveness of scaled-up interventions that use digital delivery modes. A process evaluation focused on the PA4E1 website was undertaken. Objective The 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school champions (PE teachers leading the program within their schools) and PE teachers using quantitative methods; (2) examine the usage, subjective experience, and usability of the PA4E1 program website from the perspective of in-school champions using mixed methods. Methods The first objective used website usage data collected across all users (n=273) throughout the 9 school terms of the PA4E1 implementation support. The 4 usage measures were sessions, page views, average session duration, and downloads. Descriptive statistics were calculated and explored across the duration of the 26-month program. The second objective used mixed methods, triangulating data from the first objective with data from a think-aloud survey and usability test completed by in-school champions (n=13) at 12 months. Qualitative data were analyzed thematically alongside descriptive statistics from the quantitative data in a triangulation matrix, generating cross-cutting themes using the “following a thread” approach. Results For the first objective, in-school champions averaged 48.0 sessions per user, PE teachers 5.8 sessions. PE teacher sessions were of longer duration (10.5 vs 7.6 minutes) and included more page views (5.4 vs 3.4). The results from the mixed methods analysis for the second objective found 9 themes and 2 meta-themes. The first meta-theme indicated that the website was an acceptable and appropriate delivery mode, and usability of the website was high. The second meta-theme found that the website content was acceptable and appropriate, and identified specific suggestions for improvement. Conclusions Digital health interventions targeting physical activity often experience issues of lack of user engagement. By contrast, the findings from both the quantitative and mixed methods analyses indicate high usage and overall acceptability and appropriateness of the PA4E1 website to school teachers. The findings support the value of the website within a multidelivery mode implementation intervention to support schools to implement physical activity promoting practices. The analysis identified suggested intervention refinements, which may be adopted for future iterations and further scale-up of the PA4E1 program. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12617000681358; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870
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5

Ponsoda, Xavier, Cristina Núñez, José Vicente Castell, and Maria José Gómez-Lechón. "Evaluation of the Cytotoxic Effects of MEIC Chemicals 31–50 on Primary Culture of Rat Hepatocytes and Hepatic and Non-hepatic Cell Lines." Alternatives to Laboratory Animals 25, no. 4 (July 1997): 423–36. http://dx.doi.org/10.1177/026119299702500405.

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The cytotoxicities of 20 chemicals (numbers 31–50) from the Multicenter Evaluation of In Vitro Cytotoxicity (MEIC) programme were assessed with a primary culture of rat hepatocytes and with two hepatic cell lines (Hep G2 and FaO) and one non-hepatic cell line (3T3). The cytotoxicities of the chemicals were evaluated by using the MTT test after the cells had been exposed to the chemicals for 24 hours. For a better evaluation of results, dose–response curves were mathematically linearised and cytotoxicity was expressed as IC50 values and IC10 values (the concentration causing 50% and 10% loss of cell viability, respectively). We found that all the compounds showed similar acute basal cytotoxicity in all four cellular systems (regardless of whether the cells were, or were not, metabolically competent or were or were not of human origin). When these results were used to predicit human toxicity in terms of a mathematical parameter (prediction error [PE]), we found that all four systems gave similar predictions of human toxicity. The best cytotoxicity parameter included in the PE calculation was the IC50/10, because of an underestimation of human toxicity by in vitro systems. However, when PEs were calculated for rodent toxicity, better results were obtained. Data from the literature obtained by using other experimental models for predicting human toxicity were analysed according to the same criteria. We conclude that cellular systems are better predictive tools for human toxicity than are prokaryotic cells or whole-organism models.
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López-Gil, José Francisco, Iván Cavero-Redondo, Pedro Juan Tárraga-López, Edina Maria de Camargo, Irene Sequí-Domínguez, Juan Luis Yuste Lucas, Fernando Renato Cavichiolli, and Antonio García-Hermoso. "Intensity of Physical Activity in Physical Education Classes and School Recesses and Its Associations with Body Mass Index and Global Fitness Score in Spanish Schoolchildren." Applied Sciences 11, no. 23 (November 30, 2021): 11337. http://dx.doi.org/10.3390/app112311337.

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Background: Examining the association between excess weight or physical fitness and intensity of physical activity (PA) during Physical Education (PE) classes or school recesses and in children could be of great interest and importance, especially for future intervention programs or public policies related to PA. The aim of this study was to explore the association between intensity of PA in PE classes or school recesses and excess weight or global physical fitness in a sample of Spanish schoolchildren. Methods: We performed a cross-sectional study in the Valle de Ricote (Region of Murcia, Spain). A final sample of 350 Spanish schoolchildren between 6 and 13 years of age was included from six different schools. Intensity of PA during PE classes and recesses was assessed by the Physical Activity Questionnaire for Older Children (PAQ-C). To assess physical fitness, the extended ALPHA fitness test battery was used. Body mass index (z-score) was calculated following the age- and sex-specific thresholds of the World Health Organization. Results: Both body mass index (z-score) and Global Fitness Score (z-score) were lower in schoolchildren engaging in high intensity of PA in both PE lessons and school (p < 0.05 for all). Lower odds of having excess weight were found in those who reported high intensity of PA in both PE classes and school recesses (OR = 0.54; CI 95%, 0.30–0.96). In these same participants, higher odds of being in the high Global Fitness Score tertile were found (OR = 1.96; CI 95%, 1.01–3.85). Conclusions: Our study showed that higher intensity of PA in PE classes and school recesses was associated with lower excess weight and higher global physical fitness.
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7

Mease, Philip, Christina Charles-Schoeman, Stanley Cohen, Lara Fallon, John Woolcott, Huifeng Yun, Joel Kremer, et al. "Incidence of venous and arterial thromboembolic events reported in the tofacitinib rheumatoid arthritis, psoriasis and psoriatic arthritis development programmes and from real-world data." Annals of the Rheumatic Diseases 79, no. 11 (August 5, 2020): 1400–1413. http://dx.doi.org/10.1136/annrheumdis-2019-216761.

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ObjectivesTofacitinib is a Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ulcerative colitis, and has been investigated in psoriasis (PsO). Routine pharmacovigilance of an ongoing, open-label, blinded-endpoint, tofacitinib RA trial (Study A3921133; NCT02092467) in patients aged ≥50 years and with ≥1 cardiovascular risk factor identified a higher frequency of pulmonary embolism (PE) and all-cause mortality for patients receiving tofacitinib 10 mg twice daily versus those receiving tumour necrosis factor inhibitors and resulted in identification of a safety signal for tofacitinib. Here, we report the incidence of deep vein thrombosis (DVT), PE, venous thromboembolism (VTE; DVT or PE) and arterial thromboembolism (ATE) from the tofacitinib RA (excluding Study A3921133), PsA and PsO development programmes and observational studies. Data from an ad hoc safety analysis of Study A3921133 are reported separately within.MethodsThis post-hoc analysis used data from separate tofacitinib RA, PsO and PsA programmes. Incidence rates (IRs; patients with events per 100 patient-years’ exposure) were calculated for DVT, PE, VTE and ATE, including for populations stratified by defined baseline cardiovascular or VTE risk factors. Observational data from the US Corrona registries (including cardiovascular risk factor stratification), IBM MarketScan research database and the US FDA Adverse Event Reporting System (FAERS) database were analysed.Results12 410 tofacitinib-treated patients from the development programmes (RA: n=7964; PsO: n=3663; PsA: n=783) were included. IRs (95% CI) of thromboembolic events among the all tofacitinib cohorts’ average tofacitinib 5 mg and 10 mg twice daily treated patients for RA, respectively, were: DVT (0.17 (0.09–0.27) and 0.15 (0.09–0.22)); PE (0.12 (0.06–0.22) and 0.13 (0.08–0.21)); ATE (0.32 (0.22–0.46) and 0.38 (0.28–0.49)). Among PsO patients, IRs were: DVT (0.06 (0.00–0.36) and 0.06 (0.02–0.15)); PE (0.13 (0.02–0.47) and 0.09 (0.04–0.19)); ATE (0.52 (0.22–1.02) and 0.22 (0.13–0.35)). Among PsA patients, IRs were: DVT (0.00 (0.00–0.28) and 0.13 (0.00–0.70)); PE (0.08 (0.00–0.43) and 0.00 (0.00–0.46)); ATE (0.31 (0.08–0.79) and 0.38 (0.08–1.11)). IRs were similar between tofacitinib doses and generally higher in patients with baseline cardiovascular or VTE risk factors. IRs from the overall Corrona populations and in Corrona RA patients (including tofacitinib-naïve/biologic disease-modifying antirheumatic drug-treated and tofacitinib-treated) with baseline cardiovascular risk factors were similar to IRs observed among the corresponding patients in the tofacitinib development programme. No signals of disproportionate reporting of DVT, PE or ATE with tofacitinib were identified in the FAERS database.ConclusionsDVT, PE and ATE IRs in the tofacitinib RA, PsO and PsA programmes were similar across tofacitinib doses, and generally consistent with observational data and published IRs of other treatments. As expected, IRs of thromboembolic events were elevated in patients with versus without baseline cardiovascular or VTE risk factors, and were broadly consistent with those observed in the Study A3921133 ad hoc safety analysis data, although the IR (95% CI) for PE was greater in patients treated with tofacitinib 10 mg twice daily in Study A3921133 (0.54 (0.32–0.87)), versus patients with baseline cardiovascular risk factors treated with tofacitinib 10 mg twice daily in the RA programme (0.24 (0.13–0.41)).
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Jiang, Man, Hongli Yu, Juan He, Guoping Qian, and Marcin Bialas. "Professional Development Workshop for Physical Education Teachers in Southwest China: Benefiting Tai Chi Students with Pedagogical Content Knowledge." Sustainability 15, no. 13 (July 4, 2023): 10541. http://dx.doi.org/10.3390/su151310541.

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Researchers have examined the common and specialized content knowledge (CCK/SCK) of physical education (PE) teachers and compared their pedagogical content knowledge (PCK) with student learning outcomes globally. However, little research has been reported in China on the relationship between PCK and student learning in PE settings. The aims of the study were (i) to investigate the influence of teacher content knowledge (CCK/SCK) on student development stages in PE settings and (ii) to examine the impact of teachers’ PCK on students’ performance in Tai Chi techniques (TCTs) after six days of instruction. Two PE teachers were chosen from two urban, public, mid-sized middle schools located in Chengdu, Sichuan Province, China. This study involved 332 students from six 5th and six 6th grade classes. The study consisted of 185 5th-grade students (98 boys and 87 girls) and 147 6th-grade students (70 boys and 77 girls). We examined how teacher PCK and student TCT changed after a professional development workshop (PDW). Each PE teacher had two classes randomly assigned to the control or experimental condition groups. This study had three phases. Initially, the control condition was introduced; then, a PDW was provided for the teachers; and finally, the experimental condition was implemented. Teaching behaviors were described using mean values, and t-tests based on the highest TCT scores were conducted to examine the effect of teachers’ PCK on students’ TCT learning. Furthermore, PCK effect sizes were calculated using Cohen’s d. Significant relationships existed between teachers’ PCK, CK, and students’ knowledge, with effect sizes ranging from 1.92 to 6.82. Additionally, improvements in teachers’ PCK were associated with improved TCT performance in students (p < 0.05). Increased knowledge and skills can improve teachers’ PCK behavior, resulting in improved student performance in TCTs. These findings may provide evidence for future recommendations regarding knowledge and skill training programs for physical education teachers.
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Kamphorst, Samuel Henrique, Gabriel Moreno Bernardo Gonçalves, Antônio Teixeira do Amaral Júnior, Valter Jário de Lima, Kátia Fabiane Medeiros Schmitt, Jhean Torres Leite, Valdinei Cruz Azeredo, et al. "Supporting Physiological Trait for Indirect Selection for Grain Yield in Drought-Stressed Popcorn." Plants 10, no. 8 (July 23, 2021): 1510. http://dx.doi.org/10.3390/plants10081510.

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The identification of traits associated with drought tolerance in popcorn is a contribution to support selection of superior plants under soil water deficit. The objective of this study was to choose morphological traits and the leaf greenness index, measured on different dates, to estimate grain yield (GY) and popping expansion (PE), evaluated in a set of 20 popcorn lines with different genealogies, estimated by multiple regression models. The variables were divided into three groups: morpho-agronomic traits—100-grain weight (GW), prolificacy (PR), tassel length (TL), number of tassel branches, anthesis-silking interval, leaf angle (FA) and leaf rolling (FB); variables related to the intensity of leaf greenness during the grain-filling period, at the leaf level, measured by a portable chlorophyll meter (SPAD) and at the canopy level, calculated as the normalized difference vegetation index (NDVI). The inbred lines were cultivated under two water conditions: well-watered (WW), maintained at field capacity, and water stress (WS), for which irrigation was stopped before male flowering. The traits GY (55%) and PE (28%) were most affected by water restriction. Among the morpho-agronomic traits, GW and PR were markedly reduced (>10%). Under dry conditions, the FA in relation to the plant stalk tended to be wider, the FB curvature greater and leaf senescence accelerated (>15% at 22 days after male flowering). The use of multiple regression for the selection of predictive traits proved to be a useful tool for the identification of groups of adequate traits to efficiently predict the economically most important features of popcorn (GY and PE). The SPAD index measured 17 days after male flowering proved useful to select indirectly for GY, while, among the morphological traits, TL stood out for the same purpose. Of all traits, PR was most strongly related with PE under WS, indicating its use in breeding programs. The exploitation of these traits by indirect selection is expected to induce increments in GY and PE.
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Sá, Carlos André de Souza, Magna Soelma Beserra De Moura, Josiclêda Domiciano Galvíncio, Rodrigo de Queiroga Miranda, Marcelo José Da Silva, and Cloves Vilas Boas Dos Santos. "DETECÇÃO SEMIAUTOMÁTICA DE ÁRVORES EM POMAR DE MANGUEIRA IRRIGADA A PARTIR DE IMAGENS OBTIDAS POR DRONE." IRRIGA 26, no. 3 (November 18, 2021): 507–24. http://dx.doi.org/10.15809/irriga.2021v26n3p507-524.

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DETECÇÃO SEMIAUTOMÁTICA DE ÁRVORES EM POMAR DE MANGUEIRA IRRIGADA A PARTIR DE IMAGENS OBTIDAS POR DRONE CARLOS ANDRÉ DE SOUZA SÁ1; MAGNA SOELMA BESERRA DE MOURA1,2; JOSICLÊDA DOMICIANO GALVÍNCIO3; RODRIGO DE QUEIROGA MIRANDA3; MARCELO JOSÉ DA SILVA4 E CLOVES VILAS BOAS DOS SANTOS3 1 Programa de Pós Graduação em Engenharia Agrícola, Universidade Federal do Vale do São Francisco, Av. Antônio Carlos Magalhães, 510, Santo Antônio, CEP 48.903-210, Juazeiro, BA, Brasil, carlosandreagronomia@outlook.com; magna.soelma@gmail.com. 2 Embrapa Semiárido, BR 428, Km 152, s/n, Zona Rural, Petrolina, PE, Brasil, magna.moura@embrapa.br. 3 Programa de Pós Graduação em Desenvolvimento e Meio Ambiente, Universidade Federal de Pernambuco, Av. Acadêmico Hélio Ramos, s/n, Cidade Universitária, 50.740-530, Recife, PE, Brasil, josicleda.galvincio@ufpe.br, rodrigo.qmiranda@gmail.com, clovesvilasboas@gmail.com. 4 Programa de Pós Graduação em Engenharia Agrícola, Universidade Federal Rural de Pernambuco, Rua Dom Manuel de Medeiros, s/n, Dois Irmãos, CEP 52.171-900, Recife, PE, Brasil, marcelosilvaagr@gmail.com. 1 RESUMO O monitoramento da população de plantas em áreas agrícolas é fundamental para acompanhar a produtividade, auxiliar no planejamento e na tomada de decisão. Assim, objetivou-se propor um protocolo para identificação remota de árvores de mangueiras no Submédio do Vale do São Francisco por meio de softwares e plugins gratuitos aplicados em imagens aéreas obtidas com drones. O estudo foi desenvolvido em três pomares de mangueira, empregando-se modelos digitais obtidos a partir de ortomosaicos gerados em três qualidades de processamento; avaliados no QGIS utilizando-se os plugins ‘Tree Density Calculator’ e ‘SAGA GIS’. Os resultados obtidos foram avaliados por meio dos índices de Precisão, Revocação e F1–Score. O índice de Precisão foi mais elevado para o processamento em qualidade baixa. O índice de Revocação apresentou maiores valores no processamento em qualidade média e elevada, indicando que quanto maior a qualidade do processamento, maior é a chance de acertar na contagem de árvores. Os maiores valores de F1–Score foram observados para o Tree Density Calculator com processamento na resolução baixa. Recomenda-se o uso de um protocolo para a identificação e contagem remota de árvores de mangueiras, de forma semiautomática por meio da utilização de imagens obtidas por VANTs e softwares de código livre e aberto. Palavras-chave: Identificação de árvores, mangicultura, sensoriamento remoto, veículo aéreo não tripulado. SÁ, C. A. S.; MOURA, M. S. B.; GALVÍNCIO, J. D.; MIRANDA, R. Q.; SILVA, M. J.; SANTOS, C. V. B. SEMIAUTOMATIC DETECTION OF TREES IN IRRIGATED MANGO ORCHARD FROM DRONE IMAGES 2 ABSTRACT The monitoring of plant populations in agricultural areas is essential to follow the productivity, assisting in planning and decision making. Thus, our objective was to propose a protocol for remote detection of mango trees in the Low-Middle of the Sao Francisco River Valley, by using free software and plugins applied on aerial drone images. The study was conducted in three mango orchards. We used digital models extracted from orthomosaics created under three level of quality; then they were evaluated on the package QGIS with the plugins ‘Tree Density Calculator’ and ‘SAGA GIS’. The results were evaluated with the indices Precision, Recall and F1–Score. The precision index was higher for low-quality processing; while the recall index showed higher values under medium and high quality, indicating that the higher the quality of the processing, the greater is the chance of acquiring an efficient tree counting. The highest F1–Score values were observed for the Tree Density Calculator plugin with low processing resolution. We recommend using this protocol for the remote identification and counting of mango trees, in a semiautomatic methodology by using aerial images obtained using drones and free software and plugins. Keywords: Identification of trees, mango cultivation, remote sensing, unmanned aerial vehicle.
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Dondanville, Katherine A., Brooke A. Fina, Victoria L. Steigerwald, Katherine D. McCarthy, Courtney Worley, Casey L. Straud, John C. Moring, and David C. Rozek. "How often do community-based mental health providers educate and initiate PTSD treatment following training? Answering the question of reach." Implementation Research and Practice 2 (January 2021): 263348952110117. http://dx.doi.org/10.1177/26334895211011771.

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Background: Posttraumatic stress disorder (PTSD) is a significant problem. Clinical practice guidelines recommend evidence-based treatments (EBTs) including cognitive processing therapy (CPT) and prolonged exposure (PE) as first-line treatments. Training in EBTs for PTSD has often been limited to large-scale systems (e.g., U.S. Department of Veterans Affairs). Research has shown that veteran-serving community-based mental health providers have low rates of training and supervision in EBTs for PTSD, suggesting that training initiatives for these community providers are critical to increase accessibility. This study aimed to examine the reach of education about EBTs for PTSD and the initiation of EBT for PTSD treatment among veteran-serving community-based providers participating in a large-scale training initiative. Methods: Participants ( N = 280) were community-based, licensed mental health providers who received training in CPT (67%) or PE (33%). Provider attitudes toward EBTs were measured with the Perceived Characteristics of Intervention Scale. Reach was calculated from provider self-reported follow-up survey data, including caseload total number of patients with PTSD, number of patients provided education on EBTs for PTSD, and patient initiation of EBT for PTSD. Reach was calculated for both education and EBT initiation. Results: Providers reported positive attitudes toward CPT and PE. Rates of education reach for EBTs for PTSD ranged from 30% to 76%, and rates of EBTs for PTSD initiation ranged from 11% to 35% over the 5-month follow-up period. CPT providers had higher rates of education and initiation earlier in the follow-up period, although differences in initiation rates diminished after 3 months posttraining. Conclusion: Overall, this study examined how large-scale, training programs can be used to increase the education reach and initiation reach of EBTs for PTSD among veteran-serving community-based providers. Future work should examine how best to augment these training programs to reduce the gap between education and implementation of EBTs for PTSD. Plain Language Summary Posttraumatic stress disorder (PTSD) is a significant problem among veterans. Although there are effective treatments for PTSD, mental health providers in community settings rarely have access to training in these treatments. Training programs are designed to offer providers the necessary training and support to deliver the most effective therapies to their clients. In evaluating these programs, it is important to determine whether they increase the likelihood that providers will deliver the interventions in which they were trained. Valuable outcomes include the percentage of patients who were educated on the specific intervention and who began to receive it. The (STRONG STAR) Training stron Initiative is a large-scale, community-based program that specializes in training providers in two leading PTSD therapies: cognitive processing therapy and prolonged exposure. Participants received a 2-day workshop, online resources, and weekly consultation calls to aid in the delivery of the intervention in which they were trained. Consequently, a large number of clients on provider caseloads are now aware of these PTSD treatments, and many have chosen to receive them. It is clear that the components within the (STRONG STAR) Training Initiative increase providers’ competency in delivering therapies that have been widely studied. Therefore, more community members with PTSD will have access to gold-standard care. More funding should be devoted toward competency-based training programs to increase the number of people who receive education about and who engage in delivering effective therapies. This approach will ensure high-quality care and increased quality of life for those seeking treatment from community providers.
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Craig, Brandon, Xiaolin Wang, Jeanne Sandella, Tsung-Hsun Tsai, David Kuo, and Charles Finch. "Examining concurrent validity between COMLEX-USA Level 2-Cognitive Evaluation and COMLEX-USA Level 2-Performance Evaluation." Journal of Osteopathic Medicine 121, no. 8 (May 13, 2021): 687–91. http://dx.doi.org/10.1515/jom-2021-0007.

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Abstract Context The Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) is a three level examination used as a pathway to licensure for students in osteopathic medical education programs. COMLEX-USA Level 2 includes a written assessment of Fundamental Clinical Sciences for Osteopathic Medical Practice (Level 2-Cognitive Evaluation [L2-CE]) delivered in a computer based format and separate performance evaluation (Level 2-Performance Evaluation [L2-PE]) administered through live encounters with standardized patients. L2-PE was designed to augment L2-CE. It is expected that the two examinations measure related yet distinct constructs. Objectives To explore the concurrent validity of L2-CE with L2-PE. Methods First attempt test scores were obtained from the National Board of Osteopathic Medical Examiners database for 6,639 candidates who took L2-CE between June 2019 and May 2020 and matched to the students’ L2-PE scores. The sample represented all colleges of osteopathic medicine and 97.5% of candidates who took L2-CE during the complete 2019–2020 test cycle. We calculated disattenuated correlations between the total score for L2-CE, the L2-CE scores for the seven competency domains (CD1 through CD7), and the L2-PE scores for the Humanistic Domain (HM) and Biomedical/Biomechanical Domain (BM). All scores were on continuous scales. Results Pearson correlations ranged from 0.10 to 0.88 and were all statically significant (p<0.01). L2-CE total score was most strongly correlated with CD2 (0.88) and CD3 (0.85). Pearson correlations between the L2-CE competency domain subscores ranged from 0.17 to 0.70, and correlations which included either HM or BM ranged from 0.10 to 0.34 with the strongest of those correlations being between BM and L2-CE total score (0.34) as well as between HM and BM (0.28).The largest increase between corresponding Pearson and disattenuated correlations was for pairs of scores with lower reliabilities such as CD5 and CD6, which had a Pearson correlation of 0.17 and a disattenuated correlation of 0.68. The smallest increase in correlations was observed in pairs of scores with larger reliabilities such as L2-CE total score and HM, which had a Pearson correlation of 0.23 and a disattenuated correlation of 0.28. The reliability of L2-CE was 0.87, 0.81 for HM, and 0.73 for BM. The reliabilities for the L2-CE competency domain scores ranged from 0.22 to 0.74. The small to moderate correlations between the L2-CE total score and the two L2-PE support the expectation that these examinations measure related but distinct constructs. The correlations between L2-PE and L2-CE competency domain subscores reflect the distribution of items defined by the L2-PE blueprint, providing evidence that the examinations are performing as designed. Conclusions This study provides evidence supporting the validity of the blueprints for constructing COMLEX-USA Levels 2-CE and 2-PE examinations in concert with the purpose and nature of the examinations.
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Pryimakov, Oleksandr, Marek Sawczuk, Stanislav Prysiazhniuk, Georgiy Korobeynikov, and Nataliya Mazurok. "Interaction of integral parameters of physical state and biological age of students aged 17-19 years old in the process of adaptation to standard and experimental physical education programs." Physical Education of Students 28, no. 2 (April 30, 2024): 120–33. http://dx.doi.org/10.15561/20755279.2024.0209.

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Background and Study Aim. The process of adaptation to physical education programs is a critical factor influencing the health and physical development of students. Understanding how these programs affect both the physical state and biological age of students can significantly improve their effectiveness. The aim of the study is to investigate the interaction between integral parameters of physical state (PS) and biological age (BA) of students aged 17-19 years old in the process of adaptation to standard and experimental physical education (PE) programs. Material and Methods. The study involved 140 first-year students of the National University of Telecommunications - 80 males and 60 females. In the course of the research, the indices of functional state, physical fitness (PF) and physical development (PD), biological age (BA) were recorded in young men and women of the control (CG) and experimental (EG) groups. To process the experimental material, methods of dispersion and canonical analysis were used and multiple correlation and determination coefficients were calculated. Results. It was revealed that the impact of PS integral parameters on students' BA is stronger than the inverse influence of BA on PS parameters. The degree of BA reduction under the influence of the studied factors is most pronounced in the EG of girls and boys. The variability of the group of PD and PF indices is accompanied by the variability of most of the BA parameters’ dispersion in all studied groups of students. The factor of gender has the greatest impact on the BA of students. Girls have lower initial values of BA and it’s a more pronounced decrease by the end of the experiment. The effectiveness of the impact of an aerobically oriented experimental program on the improvement of students’ PS and reduction of BA was confirmed. Under the influence of the experimental program, the BA of EG girls decreases to a greater extent in comparison with EG boys and students of both control groups. Changes and differences in BA of boys and girls of EG and CG are due to the combined impact of the factor of PE software and that of adaptation changes of students' PS in the annual process of PE. In the group of boys and girls more pronounced influence on BA in the course of the experiment was produced by the factor of software and adaptation changes, respectively. Conclusions. The gender factor has the strongest impact on students' BA - girls have lower initial values of BA and it’s a more pronounced decrease by the end of the experiment in comparison with boys. Adaptation changes of PS in the process of software implementation are accompanied by a decrease in BA in the experimental groups. One of the criteria and confirmations of the effectiveness of the developed PE program is the degree of mutual influence of PS integral parameters, which is most pronounced in the reduction of BA in the experimental groups of girls and boys.
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GUIMARÃES, AMANDA GONÇALVES, ANTÔNIO TEIXEIRA DO AMARAL JÚNIOR, GUILHERME FERREIRA PENA, JANEO EUSTÁQUIO DE ALMEIDA FILHO, MESSIAS GONZAGA PEREIRA, and PEDRO HENRIQUE ARAÚJO DINIZ SANTOS. "GENETIC GAINS IN THE POPCORN POPULATION UENF-14: DEVELOPING THE NINTH GENERATION OF INTRAPOPULATION RECURRENT SELECTION." Revista Caatinga 32, no. 3 (September 2019): 625–33. http://dx.doi.org/10.1590/1983-21252019v32n307rc.

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ABSTRACT The occurrence of negative correlations between grain yield (GY) and popping expansion (PE) in popcorn complicates the selection process. In an attempt to overcome this inconvenience, we proposed the use of the importance characteristic volume per popcorn per hectare (PV). The objectives of this study were to develop the ninth cycle of the UENF-14 popcorn population, to estimate the direct and indirect effects of PV and to verify the genetic progress among all selective cycles. We obtained and evaluated 200 inbred progenies in randomised blocks arranged in replicates within sets, with nine sets consisting of 25 progenies and one set with all previous eight cycles with three replicates. The average height of the plants, prolificacy, 100-grain weight, grain yield, grain popping expansion and volume per popcorn per hectare were evaluated. Track analysis was performed to determine the direct and indirect effects, and the Mulamba and Mock selection index was calculated for the selection of the 40 superior progenies. There was genetic variability among progenies in all evaluated traits, with a cause-and-effect relationship between PV with GY and PE, allowing simultaneous gains with indirect selection. The selection of the best progenies was more effective when using arbitrarily assigned weights, which provided higher predicted gains for PV (20.73%). The means obtained in all cycles indicated increases, demonstrating the efficiency of using continuous recurrent selection in popcorn breeding programs.
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OLIVEIRA, WANDERSON JOSÉ DE, MARIO MONTEIRO ROLIM, GERÔNIMO FERREIRA DA SILVA, MANASSÉS MESQUITA DA SILVA, CERES DUARTE GUEDES CABRAL DE ALMEIDA, and EVANILSON PAULINO DA SILVA. "FUNÇÃO DE PRODUÇÃO E RENDIMENTO DA CANA-DE-AÇÚCAR CULTIVADA SOB DIFERENTES MANEJOS HÍDRICO, NUTRICIONAL E SUBSOLAGEM." IRRIGA 28, no. 1 (March 30, 2023): 93–112. http://dx.doi.org/10.15809/irriga.2023v28n1p93-102.

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FUNÇÃO DE PRODUÇÃO E RENDIMENTO DA CANA-DE-AÇÚCAR CULTIVADA SOB DIFERENTES MANEJOS HÍDRICO, NUTRICIONAL E SUBSOLAGEM1 WANDERSON JOSÉ DE OLIVEIRA2; MARIO MONTEIRO ROLIM3; GERÔNIMO FERREIRA DA SILVA4; MANASSÉS MESQUITA DA SILVA5; CERES DUARTE GUEDES CABRAL DE ALMEIDA6 E EVANILSON PAULINO DA SILVA7 1Parte da tese de doutorado do primeiro autor, apresentada ao Programa de Pós-graduação em Engenharia Agrícola, Universidade Federal Rural de Pernambuco, Campus Recife, Recife PE, Brasil. 2Secretaria de Educação de Pernambuco, Governo do Estado de Pernambuco, Av. Afonso Olindense, n° 1513, CEP - 50810-000, Recife PE, Brasil, wanderson.jdoliveira@professor.educacao.pe.gov.br 3 Departamento de Engenharia Agrícola, Universidade Federal Rural de Pernambuco, Rua Dom Manoel de Medeiros, s/n, Dois Irmãos, CEP – 52171-900, Recife PE, Brasil, mario.rolim@ufrpe.br evanilson.psilva@gmail.com 4 Departamento de Engenharia Agrícola, Universidade Federal Rural de Pernambuco, Rua Dom Manoel de Medeiros, s/n, Dois Irmãos, CEP – 52171-900, Recife PE, Brasil, geronimo.silva@ufrpe.br 5 Departamento de Engenharia Agrícola, Universidade Federal Rural de Pernambuco, Rua Dom Manoel de Medeiros, s/n, Dois Irmãos, CEP – 52171-900, Recife PE, Brasil, manasses.mesquita@ufrpe.br 6 Colégio Dom Agostinho Ikas, Universidade Federal Rural de Pernambuco, Rodovia PE 05 Km 25, n° 4000, Tiúma, CEP - 54.737-200, Lourenço da Mata PE, Brasil, ceres.cabral@ufrpe.br 7 Estação Experimental de Cana-de-açúcar de Carpina, Universidade Federal Rural de Pernambuco, Rua Ângela Cristina Canto Pessoa de Luna, s/n, Bairro Novo, CEP - 55812-010, Carpina PE, Brasil, evanilson.psilva@gmail.com 1 RESUMO Com o objetivo de identificar a função de produção que estima o máximo rendimento de açúcar e álcool na cana-de-açúcar cultivada com diferentes doses de nitrogênio, lâminas de irrigação em solo com e sem subsolagem, foi realizado um experimento em campo com cana soca. Os tratamentos consistiram em quatro lâminas de irrigação (0, 50, 100 e 150% da ETC) e 5 doses de N (0, 40, 80, 120 e 160 kg ha-1). Foi utilizado um delineamento de 5x4x2 com 3 repetições em blocos inteiramente casualizados. A produtividade foi obtida por meio da pesagem dos colmos. A partir da função de produção foram determinadas a região de produção máxima, a taxa marginal de substituição e a região de produção racional. Através da produtividade foram calculados os rendimentos de açúcar e álcool. As lâminas, doses de N e produtividades máximas encontradas foram, de 2033 mm, 131 Mg ha-1 e 125 Mg ha-1 no solo sem subsolagem e de 1729 mm, 137 Mg ha-1 e 127 Mg ha-1 no solo com subsolagem. Para o maior rendimento de açúcar e álcool a aplicação de insumos deve permanecer nas doses de N entre 80 a 160 kg ha-1 e lâminas entre 1456 e 1731 mm. Palavras-chave: curva de isoproduto, Saccharum officinarum, taxa marginal, álcool. OLIVEIRA, W. J; ROLIM, M. M.; SILVA, G. F.; SILVA, M. M.; ALMEIDA, C. D. G.C.; SILVA, E. P. FUNCTION OF PRODUCTION AND YIELD IN SUGAR CANE CULTIVATED UNDER DIFFERENT MANAGEMENT NUTRITIONAL AND WATER AND SUBSOLATION 2 ABSTRACT With the objective of identifying the production function that estimates the maximum yield of sugar and alcohol in sugarcane cultivated with different doses of nitrogen, irrigation depths in soil with and without subsoiling, an experiment was carried out in the field with ratoon cane. Treatments consisted of four irrigation depths (0, 50, 100 and 150% of ETC) and 5 N doses (0, 40, 80, 120 and 160 kg ha-1). A 5x4x2 design with 3 replications in completely randomized blocks was used. Productivity was obtained by weighing the stalks. From the production function, the region of maximum production, the marginal rate of substitution and the region of rational production were determined. Through productivity, the yields of sugar and alcohol were calculated. The depths, N doses and maximum productivity found were 2033 mm, 131 Mg ha-1 and 125 Mg ha-1 in the soil without subsoiling and 1729 mm, 137 Mg ha-1 and 127 Mg ha-1 in the soil with subsoiling. For the highest yield of sugar and alcohol, the application of inputs should remain at doses of N between 80 and 160 kg ha-1 and depths between 1456 and 1731 mm. Keywords: yield function, isoproduct curve, Saccharum officinarum, marginal rate, alcohol.
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Veira, Alini Mari, Luan Sousa Dos Santos, Danilo Alves Marçal, Antonio Diego Brandão Brandao Melo, and Luciano Hauschild. "PSII-20 Feeding behavior of pigs fed dietary amino acid levels adjusted according to the circadian rhythm." Journal of Animal Science 102, Supplement_2 (May 1, 2024): 293–95. http://dx.doi.org/10.1093/jas/skae102.334.

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Abstract Pigs are diurnal animals that present feed intake during daylight hours, with feeding peaks in the early morning and late afternoon. However, it is possible that the concentration of amino acids (AA) in the diet throughout the day changes the meal pattern of the pigs. Therefore, the objective of this study was to evaluate the feeding behavior of growing-finishing pigs subjected to adjustment of the concentration of AA in the diet according to the circadian rhythm. Sixty-eight (body weight = 25 kg ± 2.67) barrows were assigned to four treatments, being a daily feeding program (DP) and three sequential feeding programs (SEQ). In DP, dietary AA concentration was adjusted daily, providing 100% of the standardized ileal digestibility (SID) recommendation for the 24-h period. In SEQ, the daily dietary AA concentration was adjusted every 12 h, providing a low AA concentration from 0000 to 1159 h and a high AA concentration from 1200 to 2359 h. The low and high AA concentrations of the SEQ corresponded to ±20%, ±30% and ±40% of daily AA requirements. The experiment lasted 82 d and was divided into three phases. Meal pattern variables were recorded in real time by precision feeders. The information obtained was grouped into four periods: PE1, from 0000-0600 h; PE2, 0601-12:00 h; PE3, 1201-1800 h; and PE4, 1801-2359 h. From this database, the visits to the feeder (n), meals (n), amount of time feeding (min), feed intake (g), and feed intake rate (g/min) were calculated for each period, within each experimental phase. The analysis of variance was performed considering the effects of feeding programs (FP), periods (PE), and their interaction (FP×PE), considered significant when P &lt; 0.05. There was no interaction between FP and PE (P &gt; 0.05; Table1). The visits to the feeder were greater (P &lt; 0.01) in PE2 and PE3 compared with PE1 in phase one and compared with PE1 and PE4 in phases two and three. The meals, amount of time feeding, and feed intake was greater (P &lt; 0.01) in PE2 and PE3 in all phases. Regarding feed intake rate, an PE effect (P ≤ 0.01) was observed in all phases and there was an effect of FP (P &lt; 0.01) in phases one and three. In phase one, pigs ingested feed faster in PE3 than PE1, and in phase three feed intake rate in PE1 was less than in the other (P &lt; 0.01). During phase one, SEQ40 feed intake rate was lower than SEQ30, while in phase three SEQ40 showed lower feed intake rate compared with SEQ30 and DP. Pigs showed greater feeding activity from 0600 to 1800 h. The AA concentration in the diet adjusted according to the circadian rhythm did not change the meal pattern of the pigs throughout the day. However, a decreased feed intake rate was observed in SEQ40 group in phases one and three.
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Patel, Vivek, Karine Tawagi, Samantha Ann Armstrong, Daniel Hausrath, Inas Abuali, Sean Taasan, Agrima Mian, et al. "Integration of a focused podcast curriculum (PC) to improve hematology oncology fellow (HOF) knowledge: A multi-center cluster randomized controlled trial." Journal of Clinical Oncology 42, no. 16_suppl (June 1, 2024): 9041. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.9041.

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9041 Background: Several studies demonstrate widespread use of medical podcasts as learning resources. Utility of integration of educational podcasts in fellowship curricula remains unknown. Here we describe a multicenter cluster randomized trial comparing a supplemental PC with standard curriculum (SC) to SC alone for HOF. Methods: HO fellowship programs in the United States were eligible. One HOF from each program was invited via email to participate as a local PI. The trial protocol was reviewed by program directors for approval. Programs were cluster randomized to novel PC with SC (intervention) or SC alone (control). Permuted block randomization stratified by program size was performed using STATA. The PC arm was given access to a website developed by the study team with links to podcasts episodes (PE) covering 4 topics: breast oncology, myeloma, bleeding disorders, and HIT. Written show notes (SN) were provided as separate links. PE and SNs were previously developed employing an inductive approach and released by The Fellow on Call and Two Onc Docs podcasts and are freely available. Pre and post qualitative surveys (QS) and knowledge assessments (KA) were administered via REDCAP. QS utilized a 7-point Likert score. KAs were peer reviewed by expert disease-specific faculty. QS and KA links were included on the PC website. To maintain blinding, the SC arm was given a separate website with these links. HOF participation was voluntary. To improve enrollment, at minimum, QS completion was required; KA was optional. Baseline data was obtained from October to November 2023. Post data cut off will be June 2024. Power calculation was based on mean difference in comfort level and knowledge. Assuming a mean improvement by 0.5 points for QS, a total sample size of 210 HOF, 11 clusters in each arm would provide at least 80% power assuming a standard deviation (SD) of 1, intracluster correlation coefficient (ICC) of 0.05, and coefficient of variation of cluster sizes of 0.7. For improvement in KA by 10%, a total sample size of 60 HOF would provide the same power assuming SD of 15%. We therefore planned to recruit 30 HO programs to account for non-response rates. IRB review deemed the study exempt. Results: Baseline characteristics from 28 randomized programs are presented below. Conclusions: This is the first randomized education trial in graduate medical education of its kind with a priori power calculations. Our innovative use of HOF as local PIs may have led to increased participation in KAs. Recruited sites will serve as a consortium for future multicenter education research. Interim analysis will be presented at ASCO 2024. [Table: see text]
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Vallejo-Yagüe, E., S. Weiler, and A. M. Burden. "OP0237 THROMBOEMBOLIC SAFETY PROFILE OF TOFACITINIB AND BARICITINIB: AN ANALYSIS OF WHO VIGIBASE." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 150.1–150. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2823.

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Background:The Janus Kinase (JAK) inhibitors tofacitinib and baricitinib are new targeted treatments for rheumatoid arthritis. Recent concerns regarding the risk of thrombosis have led to warnings by the European Medicines Agency (EMA) and the Food and Drug Administration (FDA)1,2.Objectives:To examine the safety reporting of tofacitinib and baricitinib, with focus on thromboembolic events.Methods:Individual case safety reports (ICSRs) for tofacitinib and baricitinib were retrieved from the World Health Organization (WHO) global database (VigiBase) in April 2019. The primary outcomes were deep vein thrombosis (DVT) and pulmonary thrombosis (PT) or pulmonary embolism (PE). A disproportionality analysis was conducted by estimating the reporting odds ratio (ROR) and 95% confidence intervals (CIs) to compare the observed versus expected reporting ratio of DVT or PT|PE for tofacitinib or baricitinib. The ROR were calculated worldwide and stratifying by reporting from Europe or the US. In a secondary analysis, further thrombotic-related outcomes were investigated.Results:In both tofacitinib (n=40,017) and baricitinib (n=2,138) ICSRs, patients with reported DVT or PT|PE were older and had higher reporting of pro-thrombotic medications (e.g., contraceptives) or indicators of thromboembolic risk (i.e., antithrombotic treatment). The use of tofacitinib was associated with a significant increased reporting for DVT (ROR: 2.37 95% CI 1.23-4.56) and PT|PE (ROR 2.38 95% CI 1.45-3.89) in Europe. In the US, tofacitinib was only associated with an elevated reporting of PT (ROR: 2.05 % CI 1.45-2.90). Baricitinib was associated with a 3-fold increased risk of reporting for DVT (ROR: 3.47 95% CI 2.18-5.52) or PT|PE (ROR: 3.44 95% CI 2.43-4.88) in Europe, which accounted for 97% of all baricitinib ICSRs. Secondary thrombotic-related outcomes were poorly reported overall in VigiBase.Conclusion:This study supports the cautious use of JAK inhibitors in patients with rheumatoid arthritis who have a high thrombotic risk profile. Moreover, a potential class effect of JAK inhibitors cannot be ruled out.References:[1]FDA Drug Safety Communication. Safety trial finds risk of blood clots in the lungs and death with higher dose of tofacitinib (Xeljanz, Xeljanz XR) in rheumatoid arthritis patients; FDA to investigate. Food and Drug Administration (FDA)http://www.fda.gov/drugs/drug-safety-and-availability/safety-trial-finds-risk-blood-clots-lungs-and-death-higher-dose-tofacitinib-xeljanz-xeljanz-xr(2019).[2]EMA confirms Xeljanz to be used with caution in patients at high risk of blood clots. EMA/608520/2019.https://www.ema.europa.eu/en/documents/referral/xeljanz-article-20-procedure-ema-confirms-xeljanz-be-used-caution-patients-high-risk-blood-clots_en.pdf(2019).Acknowledgments:We are thankful to every pharmacovigilance centre and contributor to the WHO Programme for International Drug Monitoring and VigiBase.While the authors used data from the VigiBase, the WHO global database of ICSRs as a source of information, the conclusions do not represent the opinion of the Uppsala Monitoring Centre (UMC) or the WHO.Disclosure of Interests:Enriqueta Vallejo-Yagüe Employee of: Synovo GmbH 2012-2018 (not related to this abstract), Stefan Weiler Consultant of: Gedeon-Richter for drug safety 2017 (not related to this abstract), Andrea Michelle Burden: None declared
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Dos Santos Junior, Gilberto Sabino, Maria Das Neves Gregório, Marcia Cristina De Souza Matos Carneiro, Eduardo Paes Barreto, Grenda Juara Alves Costa, and Weyller Diogo Albuquerque Melo. "Análise da Evolução da Linha de Costa da Região Metropolitana Sul da Cidade do Recife – PE, Brasil." Revista Brasileira de Geografia Física 13, no. 4 (June 11, 2020): 1645. http://dx.doi.org/10.26848/rbgf.v13.4.p1645-1674.

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O processo de erosão costeira vem afetando de forma contínua as praias do município do Jaboatão dos Guararapes, município da Região Metropolitana do Recife – PE. A ocupação desordenada ao longo dos últimos 42 anos tem agravado o processo erosivo nas praias deste município. A prefeitura em parceria com o governo do estado implantou a técnica de engenharia costeira conhecida como transpasse de sedimentos, engorda da praia, para contenção da erosão, mas que vem apresentando retirada de sedimentos, mesmo após a engorda. Por esta razão este trabalho teve o objetivo de analisar a variabilidade multitemporal da linha de costa do município de Jaboatão dos Guararapes. O ano de 1974 foi utilizado como referência para a realização do cálculo da taxa de deslocamento da linha de costa para os anos de 1981, 1997, 2010, 2013 e 2016, realizado no programa Arcgis 10.1. A área de estudo foi dividida em 4 (quatro) setores de sul para o norte. Foi observada uma relevante retrogradação para o Setor 1 (praia de Barra de Jangada) entre 1974 e 1981, apresentando estabilização entre 1981 e 1997. Já no Setor 2 (praia de Candeias), houve progradação no período de 1974 a 2010. Em 2013 ocorreu uma grande progradação da linha de costa, devido a execução da técnica de transpasse de sedimentos, sendo o Setor 1 o que obteve maior deslocamento da linha em relação aos anos anteriores. Para o ano de 2015 ocorreu o processo inverso, ou seja, uma grande retrogradação em toda extensão do litoral de Jaboatão, principalmente na praia de Barra de Jangada (Setor 1). A linha de costa do ano 2016 apresentou um grande recuo, apresentando semelhança em diferentes trechos nos 4 setores em relação a linha do ano de 1997. Analysis of the Evolution of the Coastline of the Metropolitan Region Aouth of the City of Recife – PE, Brasil A B S T R A C TThe process of coastal erosion has been continuously affecting the Jaboatão dos Guararapes’s beaches, city of the Metropolitan Region of Recife - PE. The disorderly occupation over the last 42 years has aggravated the erosive process in the beaches of this city. The city government in partnership with the state government implemented the coastal engineering technique known as sediment transfer, fattening the beach to contain erosion, but which has been showing sediment removal, even after fattening. For this reason, this work aimed to analyze the multitemporal variability of the coastline of the city of Jaboatão dos Guararapes. The year 1974 was used as a reference for the calculation of the shoreline displacement rate for the years 1981, 1997, 2010, 2013 and 2016, performed in the program Arcgis 10.1. The study area was divided into 4 (four) sectors from south to north. A large retrogradation was observed for Sector 1 (Barra de Jangada beach) between 1974 and 1981, showing stabilization between 1981 and 1997. In Sector 2 (Candeias beach), there was progression from 1974 to 2010. In 2013 there was a great progradation of the shoreline, due to the execution of the sediment transfer technique, being Sector 1 the one that had the largest displacement of the line in relation to previous years. For 2015, the opposite process occurred, that is, a major retrogradation in the entire length of the Jaboatão coast, especially in Barra de Jangada beach (Sector 1). The shoreline of the year 2016 showed a large setback, showing similarity in different stretches in the 4 sectors compared to the 1997 line.Key words. Sediment transfer, shoreline, erosion, fattening.
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Thottungal Suresh, Jils, and Rukumani . "A Study to Assess the Effectiveness of Planned Teaching Program on Prevention of Deep Vein Thrombosis Among Nursing Interns Working in a Selected Hospital." International Journal of Health Sciences and Research 13, no. 1 (January 12, 2023): 39–43. http://dx.doi.org/10.52403/ijhsr.20230107.

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Background: Deep Vein Thrombosis may lead to many complications like Pulmonary embolism (PE), Postphlebitic syndrome and Treatment complications like Bleeding (haemorrhage) as a side effect of blood thinners. The knowledge of health care providers, especially the nurses would make a significant impact in the early risk identification speedy recovery and prevention of these complications. Materials and Methods: A quantitative research approach was adopted for the study. A one group pre-test and post-test experimental design was used to determine the effect of planned teaching program on knowledge of staff nurses. The study comprised of 40 nursing interns working in a selected Hospital who fulfilled inclusive criteria drawn by Convenient Sampling method. A self-administered knowledge questionnaire was used for data collection. The content Validity of the tool was established in consultation with guide and 12 experts from the field of Medical Surgical Nursing, an educationist and a statistician. Reliability coefficient of knowledge questionnaire was calculated using the Karl Pearson correlation coefficient method. Further, a formal permission was obtained from authority concerned from selected hospital for data collection. Then, the Collected data were tabulated and analyzed. Results: The study revealed that the mean score among nurses was 10.5 (42%) during pre-test rose up to 20(80%) in the post-test evaluation. Result interpreted that there was a significant increase in knowledge level of nursing interns after administration of the intervention. It is evident that the calculated’ value was greater than the table value of ‘t’ at 0.05 level. This indicates that Planned teaching program was effective in improving the knowledge of the nursing interns. Conclusion: The study was done to assess the effectiveness of planned teaching program on prevention of Deep Vein Thrombosis among nursing interns. The result of this study shows that the most of the nursing interns had excellent knowledge after administration of planned teaching program. Hence, it can be concluded that the planned teaching program was found good method for achieving knowledge on DVT and its prevention. Key words: planned teaching program, knowledge, Deep Vein Thrombosis
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Kishita, Ryohei, Hideki Miyaguchi, Tomoko Ohura, Katsuhiko Arihisa, Wataru Matsushita, and Chinami Ishizuki. "Fall risk prediction ability in rehabilitation professionals: structural equation modeling using time pressure test data for Kiken-Yochi Training." PeerJ 12 (January 3, 2024): e16724. http://dx.doi.org/10.7717/peerj.16724.

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Background Falls occur frequently during rehabilitation for people with disabilities. Fall risk prediction ability (FRPA) is necessary to prevent falls and provide safe, high-quality programs. In Japan, Kiken Yochi Training (KYT) has been introduced to provide training to improve this ability. Time Pressure-KYT (TP-KYT) is an FRPA measurement specific to fall risks faced by rehabilitation professionals. However, it is unclear which FRPA factors are measured by the TP-KYT; as this score reflects clinical experience, a model can be hypothesized where differences between rehabilitation professionals (licensed) and students (not licensed) can be measured by this tool. Aims To identify the FRPA factors included in the TP-KYT and verify the FRPA factor model based the participants’ license status. Methods A total of 402 participants, with 184 rehabilitation professionals (physical and occupational therapists) working in 12 medical facilities and three nursing homes, and 218 rehabilitation students (physical and occupational therapy students) from two schools participated in this study. Participant characteristics (age, gender, job role, and years of experience and education) and TP-KYT scores were collected. The 24 TP-KYT items were qualitatively analyzed using an inductive approach based on content, and FRPA factors were extracted. Next, the correction score (acquisition score/full score: 0–1) was calculated for each extracted factor, and an observation variable for the job role (rehabilitation professional = 1, rehabilitation student = 0) was set. To verify the FRPA factors associated with having or not having a rehabilitation professional license, FRPA as a latent variable and the correction score of factors as an observed variable were set, and structural equation modeling was performed by drawing a path from the job role to FRPA. Results The results of the qualitative analysis aggregated patient ability (PA), physical environment (PE), and human environment (HE) as factors. The standardized coefficients of the model for participants with or without a rehabilitation professional license and FRPA were 0.85 (p < 0.001) for FRPA from job role, 0.58 for PA, 0.64 for PE, and 0.46 for HE from FRPA to each factor (p < 0.001). The model showed a good fit, with root mean square error of approximation < 0.001, goodness of fit index (GFI) = 0.998, and adjusted GFI = 0.990. Conclusion Of the three factors, PA and PE were common components of clinical practice guidelines for fall risk assessment, while HE was a distinctive component. The model’s goodness of fit, which comprised three FRPA factors based on whether participants did or did not have rehabilitation professional licenses, was good. The system suggested that rehabilitation professionals had a higher FRPA than students, comprising three factors. To provide safe and high-quality rehabilitation for patients, professional training to increase FRPA should incorporate the three factors into program content.
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Buekers, Jurgen, Madlen David, Gudrun Koppen, Jos Bessems, Martin Scheringer, Erik Lebret, Denis Sarigiannis, et al. "Development of Policy Relevant Human Biomonitoring Indicators for Chemical Exposure in the European Population." International Journal of Environmental Research and Public Health 15, no. 10 (September 21, 2018): 2085. http://dx.doi.org/10.3390/ijerph15102085.

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The European Union’s 7th Environmental Action Programme (EAP) aims to assess and minimize environmental health risks from the use of hazardous chemicals by 2020. From this angle, policy questions like whether an implemented policy to reduce chemical exposure has had an effect over time, whether the health of people in specific regions or subpopulations is at risk, or whether the body burden of chemical substances (the internal exposure) varies with, for example, time, country, sex, age, or socio-economic status, need to be answered. Indicators can help to synthesize complex scientific information into a few key descriptors with the purpose of providing an answer to a non-expert audience. Human biomonitoring (HBM) indicators at the European Union (EU) level are unfortunately lacking. Within the Horizon2020 European Human Biomonitoring project HBM4EU, an approach to develop European HBM indicators was worked out. To learn from and ensure interoperability with other European indicators, 15 experts from the HBM4EU project (German Umweltbundesamt (UBA), Flemish research institute VITO, University of Antwerp, European Environment Agency (EEA)), and the World Health Organization (WHO), European Core Health Indicator initiative (ECHI), Eurostat, Swiss ETH Zurich and the Czech environmental institute CENIA, and contributed to a workshop, held in June 2017 at the EEA in Copenhagen. First, selection criteria were defined to evaluate when and if results of internal chemical exposure measured by HBM, need to be translated into a European HBM-based indicator. Two main aspects are the HBM indicator’s relevance for policy, society, health, and the quality of the biomarker data (availability, comparability, ease of interpretation). Secondly, an approach for the calculation of the indicators was designed. Two types of indicators were proposed: ‘sum indicators of internal exposure’ derived directly from HBM biomarker concentrations and ‘indicators for health risk’, comparing HBM concentrations to HBM health-based guidance values (HBM HBGVs). In the latter case, both the percentage of the studied population exceeding the HBM HBGVs (PE) and the extent of exceedance (EE), calculated as the population’s exposure level divided by the HBM HBGV, can be calculated. These indicators were applied to two examples of hazardous chemicals: bisphenol A (BPA) and per- and polyfluoroalkyl substances (PFASs), which both have high policy and societal relevance and for which high quality published data were available (DEMOCOPHES, Swedish monitoring campaign). European HBM indicators help to summarize internal exposure to chemical substances among the European population and communicate to what degree environmental policies are successful in keeping internal exposures sufficiently low. The main aim of HBM indicators is to allow follow-up of chemical safety in Europe.
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Albuquerque, Francimar Da Silva, Ênio Farias de França e. Silva, Pabrício Marcos Oliveira Lopes, Geber Barbosa de Albuquerque Moura, Bernardo Barbosa da Silva, and Alexandre Hugo Cezar Barros. "APTIDÃO CLIMÁTICA DE CULTURAS AGRÍCOLAS IMPORTANTES PARA COMUNIDADES INDÍGENAS DO SEMIÁRIDO BRASILEIRO." IRRIGA 22, no. 1 (March 30, 2017): 59–73. http://dx.doi.org/10.15809/irriga.2017v22n1p59-73.

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APTIDÃO CLIMÁTICA DE CULTURAS AGRÍCOLAS IMPORTANTES PARA COMUNIDADES INDÍGENAS DO SEMIÁRIDO BRASILEIRO1 FRANCIMAR DA SILVA ALBUQUERQUE2; ÊNIO FARIAS DE FRANÇA E SILVA3; PABRÍCIO MARCOS OLIVEIRA LOPES4; GEBER BARBOSA DE ALBUQUERQUE MOURA4; BERNARDO BARBOSA DA SILVA5 E ALEXANDRE HUGO CEZAR BARROS6 1Artigo extraído da tese de doutorado do primeiro autor2Fundação Nacional do Índio-Funai/Coordenação Regional Baixo São Francisco, Rua Marechal Floriano Peixoto, 855, Centro, 48.601-210, Paulo Afonso/BA, Brasil, e-mail: franciufrpe@gmail.com3Universidade Federal Rural de Pernambuco-UFRPE/Departamento de Engenharia Agrícola/Programa de Pós-graduação em Engenharia Agrícola, Rua Dom Manoel de Medeiros, s/n, Dois Irmãos, 52.171-900, Recife/PE, Brasil, e-mail: enio.fsilva@ufrpe.br4Universidade Federal Rural de Pernambuco-UFRPE/Departamento de Agronomia/Programa de Pós-Graduação em Engenharia Agrícola, Rua Dom Manoel de Medeiros, s/n, Dois Irmãos, 52.171-900, Recife/PE, Brasil, e-mails: pabriciope@gmail.com, gebermoura@uol.com.br5Universidade Federal de Campina Grande-UFCG/Unidade Acadêmica de Ciências Atmosféricas-UACA, Av. Aprígio Veloso, 882 - Bodocongó, 58.429-900, Campina Grande/PB, Brasil, e-mail: bernardo.silva@ufcg.edu.br6Empresa Brasileira de Pesquisa Agropecuária-EMBRAPA/Centro Nacional de Pesquisa de Solos-CNPS/Unidade de Execução e Pesquisa-UEP-Recife/PE, Rua Jardim Botânico, 1.024, Jardim Botânico, 50.020-240, Rio de Janeiro/RJ, Brasil, e-mail: alexandre.barros@embrapa.br 1 RESUMO Devido ao avanço da tecnologia tornou-se possível fazer revisões antecipadas do regime pluviométrico de determinada região, e com o auxílio do zoneamento agroclimático conhecer se uma cultura terá ou não sua viabilidade no ano previsto. Objetivou-se realizar o zoneamento agroclimático de culturas de importância econômica e cultural para comunidades indígenas que estão localizadas no semiárido nordestino brasileiro. Neste trabalho foram considerados três cenários de precipitação, visando subsidiar a seleção de locais propícios para estes cultivos pelo uso da técnica dos quantis. Foram utilizados dados climáticos de 169 localidades, dos quais 52 com uma série acima de 30 anos de observações, e dados climáticos de temperatura média do ar e precipitação pluviométrica conforme o cenário seco, normal ou chuvoso, calcularam-se os balanços hídricos climatológicos segundo a metodologia de Thornthwaite (1948). De posse das informações dos balanços hídricos, foram feitas extrapolações para toda a área considerada. Analisando cada cenário de precipitação, observou-se que, no cenário seco, todas as áreas das reservas indígenas apresentaram inaptidão climática por carência hídrica acentuada para a cultura do feijão; no cenário normal, todas as áreas também foram classificadas com aptidão moderada para a cultura da mandioca; e no cenário chuvoso, todas as áreas apresentaram um período chuvoso muito longo para a cultura do milho. Palavras-chave: agricultura de sequeiro, Manihot esculenta, Vigna unguiculata, Zea mays, zoneamento agroclimático. ALBUQUERQUE, F da S.; SILVA, E. F. de F e; LOPES, P. M. O.; MOURA, G. B. de A.; SILVA, B. B. da; BARROS, A. H. C.CLIMATIC SUITABILITY OF IMPORTANT AGRICULTURAL CROPS FOR INDIGENOUS COMMUNITIES OF THE BRAZILIAN SEMIARID 2 ABSTRACT The aim of this study was to perform the agroclimatic zoning of crops of economic and cultural importance to indigenous communities that survive in the Brazilian semiarid northeast, considering three scenarios of precipitation obtained using the technique of quantile, in order to support the selection of favorable sites for these crops. Climatic data from 169 localities were used, of which 52 with a series above 30 years of observations. Based on climatic data of air average temperatures and rainfall according to dry, normal or rainy scenarios, climatic water balances were calculated, using Thornthwaite (1948) methodology. With the water balance data, the extrapolation to the entire area considered was made. Analyzing each rainfall scenario, it was observed that, in the dry scenario, all areas of indigenous reserves showed unsuitable climate due to marked water shortage bean crop; in the normal scenario, all areas were also classified with moderate suitability for cassava crop; and for the rainy scenario, all areas showed a very long rainy season for maize. Keywords: rainfed agriculture, Manihot esculenta, Vigna unguiculata, Zea mays, agroclimatic zoning.
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Sousa, Lizandra de Barros de, Abelardo Antônio de Assunção Montenegro, Thieres George Freire da Silva, Ailton Alves de Carvalho, and Moisés Alves Da Silva Neto. "ESTIMATIVA DA EVAPOTRANSPIRAÇÃO REAL E MAPEAMENTO DE ÁREAS CULTIVADAS EM UMA BACIA DO PROJETO DE INTEGRAÇÃO DO SÃO FRANCISCO (PISF), SEMIÁRIDO PERNAMBUCANO." IRRIGA 26, no. 3 (November 18, 2021): 565–83. http://dx.doi.org/10.15809/irriga.2021v26n3p565-583.

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ESTIMATIVA DA EVAPOTRANSPIRAÇÃO REAL E MAPEAMENTO DE ÁREAS CULTIVADAS EM UMA BACIA DO PROJETO DE INTEGRAÇÃO DO SÃO FRANCISCO (PISF), SEMIÁRIDO PERNAMBUCANO LIZANDRA DE BARROS DE SOUSA1; ABELARDO ANTÔNIO DE ASSUNÇÃO MONTENEGRO1; THIERES GEORGE FREIRE DA SILVA2; AILTON ALVES DE CARVALHO1 E MOISÉS ALVES DA SILVA NETO3 1 Departamento de Engenharia Agrícola (DEAGRI). Programa de Pós-Graduação em Engenharia Agrícola (PGEA). Universidade Federal Rural de Pernambuco (UFRPE). Rua Dom Manuel de Medeiros, S/N, Dois Irmãos, CEP: 52171-900, Recife/PE, Brasil. E-mail: lizandradebarros@gmail.com; montenegro.ufrpe@gmail.com; Ailtonalvesst@gmail.com. 2 Unidade Acadêmica de Serra Talhada (UAST). Universidade Federal Rural de Pernambuco (UFRPE). Avenida Gregório Ferraz Nogueira, S/N, José Tomé de Souza Ramos, CEP: 56909-535, Serra Talhada/PE, Brasil. E-mail: thigeoprofissional@hotmail.com. 3 Departamento de Engenharia Agrícola (DEAGRI). Universidade Federal Rural de Pernambuco (UFRPE). Rua Dom Manuel de Medeiros, S/N, Dois Irmãos, CEP: 52171-900, Recife/PE, Brasil. E-mail: moisesneto179@gmail.com. 1 RESUMO A região semiárida brasileira apresenta limitada disponibilidade de recursos hídricos, além disso, profundas alterações no uso e ocupação do solo estão previstas para ocorrer nas bacias hidrográficas de Pernambuco. Objetivou-se avaliar a evapotranspiração real e mapear áreas cultivadas por meio de sensoriamento remoto, utilizando, respectivamente, os modelos SAFER (Simple Algorithm for Evapotranspiration Retrieving) e SUREAL (Surface Resistance Algorithm), na Bacia do rio Terra Nova, em trecho perenizado. Imagens do satélite Landsat-8, de 2015 a 2020, foram selecionadas. Calculou-se: Índice de Vegetação da Diferença Normalizada (NDVI), albedo, temperatura de superfície, evapotranspiração de referência e evapotranspiração real. As imagens foram processadas no Google Earth Engine (GEE) e no software QGIS 3.16. Notou-se aumento no índice de cobertura vegetal. Regiões com maiores valores de evapotranspiração real estão ligadas àquelas com temperaturas mais baixas. Observou-se uma menor quantidade de áreas cultivadas no trecho do Rio Terra Nova nas imagens de 2015. Verificou-se o aumento da agricultura na região às margens desse rio, em seu trecho perenizado, de 29,5; 15,2; 7,7; 7,6; e 12,9 km² em 18/07/2016, 22/06/2018, 28/10/2018, 13/11/2018, e 20/12/2020, respectivamente. Além da intensidade de precipitação, a liberação das águas do PISF pode ter contribuído para o aumento de áreas irrigadas na região. Palavras-chave: sensoriamento remoto, agricultura irrigada, SAFER, SUREAL. SOUSA, L. B.; MONTENEGRO, A. A. A.; SILVA, T. G. F.; CARVALHO, A. A.; SILVA NETO, M. A. ESTIMATION OF ACTUAL EVAPOTRANSPIRATION AND MAPPING OF CULTIVATED AREAS IN A BASIN OF THE SÃO FRANCISCO INTEGRATION PROJECT (PISF), SEMIARID OF PERNAMBUCO STATE 2 ABSTRACT The Brazilian semi-arid region has limited availability of water resources, in addition, profound changes in land use and occupation are expected to occur in the river basins of Pernambuco. The objective was to evaluate the actual evapotranspiration and to map cultivated areas through remote sensing, using, respectively, the SAFER (Simple Algorithm for Evapotranspiration Retrieving) and SUREAL (Surface Resistance Algorithm) models, in the Terra Nova River Basin, in a perennial stretch. Landsat-8 satellite images from 2015 to 2020 were selected. The Normalized Difference Vegetation Index (NDVI), albedo, surface temperature, reference evapotranspiration, and actual evapotranspiration were calculated. Images were processed using the Google Earth Engine (GEE) platform and QGIS 3.16 software. There was an increase in the vegetation cover index. Regions with higher actual evapotranspiration values ​​are linked to those with lower temperatures. It was observed a smaller number of cultivated areas in the Terra Nova River stretch in the 2015 images. Also, it was verified an increase in agriculture in the riverside region along this, in its perennial stretch, of 29.5; 15.2; 7.7; 7.6; and 12.9 km² on 07/18/2016, 06/22/2018, 10/28/2018, 11/13/2018, and 12/20/2020, respectively. In addition to the intensity of precipitation, the release of PISF waters may have contributed to the increase in irrigated areas in the region. Keywords: remote sensing, irrigated agriculture, SAFER, SUREAL.
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Schweizer, Tess Kate, Maxime Mauduy, Juan M. Falomir-Pichastor, and Nicolas Margas. "How sport teaches values? The specific ability of intense bodily commitment to enhance norm adherence." Current Issues in Sport Science (CISS) 8, no. 2 (February 14, 2023): 028. http://dx.doi.org/10.36950/2023.2ciss028.

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Introduction Teaching norms and values through sport and physical education (PE) is a worldwide expectation (European Parliament, 2007; International Olympic Committee, 2020), even though little is known about processes that could explain such expectation (Hatzigeorgiadis et al., 2013). Identifying them is fundamental to overcome this ideology and to improve educational programs through sport. As personal values are built according to salient social norms (Jonas et al., 2008), past research in sport and educational sciences focused on identifying salient norms and values during sport practices (e.g., Whitehead et al., 2013) and on pointing out how teachers/stakeholders can make educational norms and values salient during practice (e.g., Koh et al., 2016). We propose that the singularity of sport and PE to build values does not (only) come from the type of salient values but rather from the specific capacity of sport and PE contexts to enhance adhesion to salient norms. Indeed, sport and PE place practitioners in front of challenges that require bodily commitment and induce specific emotional context of threat and arousal of the sympathetic nervous system. Because such emotional contexts enhance adhesion to ingroup norms (Fritsche & Jugert, 2017; Hart et al., 2005; Swann et al., 2010), two studies aim to demonstrate that bodily commitment in sport and PE increases adherence to salient ingroup norms. We hypothesize a normative salience effect (H1) and a norm salience x bodily commitment interaction effect (H2) on adolescents’ personal values and behavioral consequences. Method Two studies conducted in PE followed a 2 (norm salience) x 2 (bodily commitment) factorial design. One hundred and thirty-nine students (Mage = 13.97; ± 0.72; 62.1% girls, aged 13-16) took part to Study 1 and 187 (Mage = 13.59; ± 0.76; 61.5% girls, aged 12-16) to Study 2. Based on a priori power calculation (package simr, Green & Macleod, 2016), these sample size allowed us to have a sufficient statistical power of 95%. Participants first completed a preliminary questionnaire measuring personal values (Louis et al., 2009; Schwartz, 2011). Two weeks later, they participated one by one to the experimental phase. An ingroup norm was made salient, either the experimental one (pro-environmental in Study 1, healthy eating in Study 2) or the control one (anti-discrimination in Study 1 and 2), by presenting manipulated results to the preliminary questionnaire, in the form of graphic figures (Study 1) or pictures (Study 2; Gabarrot et al., 2009). They then had to do a physical exercise with weak or strong bodily commitment in climbing (Study 1) or gymnastic (Study 2). Finally, a questionnaire measured personal values (repeated measure), emotional states (arousal and threat), pro-environmental behavioral intentions (Study 1) and social desirability (Study 2) (S-CSD, Miller et al., 2014). Healthy eating self-reported behaviors were assessed one week later (Study 2). Data were analyzed using contrast with bootstrapping method as recommended by many authors (Judd et al., 2017): C1 tested the norm salience effect, C2 the bodily commitment effect in the experimental norm salience condition and C3 the bodily commitment effect in the control norm salience condition. To support our hypotheses, after controlling for initial personal values, classroom level, and social desirability effects, C1 and C2 had to be significant while C3 did not on the personal values. Then, mediating effects of our conditions on behavior measures through changes in personal values were tested. Finally, a two-studies meta-analysis was conducted on personal values and the role of arousal and threat states in producing changes in personal values was explored. Results First, bootstrap linear mixed models revealed that, in Study 1, pro-environmental personal values at T1 were positively and significantly predicted by initial pro-environmental values (Estimate = 0.72, SE = 0.05, p < .001), C1 (Estimate = 0.22, SE = 0.10, p < .05) and C2 (Estimate = 0.30, SE = 0.11, p < .01) but not by C3 (p > .05). In Study 2, the model indicated that healthy eating personal values at T1 were predicted by initial healthy eating values (Estimate = 0.64, SE = 0.03, p < .001), social desirability (Estimate = 0.64, SE = 0.09 p < .05) and C1 (Estimate = 0.34, SE = 0.09, p < .01). The influence of C2 was marginally significant (Estimate = 0.28, SE = 0.13, p = .051), while C3 (p > .05) was not significant. Second, multilevel longitudinal mediation models revealed, for Study 1, significant indirect effects of C1 (p = .03) and C2 (p = .02) on behavioral intentions through changes in pro-environmental values at T1, and for Study 2, a significant indirect effect of C1 (p = .029) on healthy eating behaviors at T2, through changes in healthy eating values at T1. Finally, the meta-analysis revealed that both C1 (d = 0.31) and C2 (d = 0.30) were positive and significant. Analyses on threat and arousal states revealed that, in Study 1, strong compared to weak bodily commitment induced greater threat states (ps < .001), although not impacting participants’ changes in pro-environmental values. In Study 2, strong compared to weak bodily commitment induced greater threat than arousal states in normative salience context (Estimate = 0.30, SE = 0.14, p = .036) and only pupils’ subjective threat significantly impacted changes in healthy eating personal values (p = .04). Discussion Results support our hypotheses, as changes of adolescents’ personal values are explained by normative salient context (H1) and the intensity of bodily commitment in this context of norm salience (H2). Effects were obtained in two studies varying bodily commitment (climbing and gymnastic task), ingroup norm (pro-environmental and healthy eating) and salience induction (graphic figures and pictures). Exploratory analysis highlighted behavioral consequences of adolescents’ changes in personal values and the specific role of threat states. Thus, these results point to a new way of explaining the singularity of sport in effectively constructing personal values of adolescents and orienting their consecutive behaviors (Agenda 2030, United Nations Educational, Scientific and Cultural Organization, 2016): First, particular attention must be paid to norms and values that are salient in sport and PE contexts and second, intense bodily commitment, especially those inducing subjective threat, are required for sport and PE to embrace their educative role. Nevertheless, our results do not suggest to only nurture threat states in sport and PE. Finally, we point to the importance of ingroup norms in the norm adherence process, but this is true whatever these norms are, and teacher/stakeholder cannot always orient the type of ingroup norm made salient during practice. References European Parliament. (2007). The on the role of sport in education. https://www.europarl.europa.eu/doceo/document/A-6-2007-0415_EN.html Fritsche, I., & Jugert, P. (2017). The consequences of economic threat for motivated social cognition and action. Current Opinion in Psychology, 18, 31-36. https://doi.org/10.1016/j.copsyc.2017.07.027 Gabarrot, F., Falomir-Pichastor, J. M., & Mugny, G. (2009). Being similar versus being equal: Intergroup similarity moderates the influence of in-group norms on discrimination and prejudice. British Journal of Social Psychology, 48(2), 253–273. https://doi.org/10.1348/014466608X342943 Green, P., & MacLeod, C. J. (2016). SIMR: An R package for power analysis of generalized linear mixed models by simulation. Methods in Ecology and Evolution, 7(4), 493-498. https://doi.org/10.1111/2041-210X.12504 Hart, J., Shaver, P. R., & Goldenberg, J. L. (2005). Attachment, self-esteem, worldviews, and terror management: Evidence for a tripartite security system. Journal of Personality and Social Psychology, 88(6), 999–1013. https://doi.org/10.1037/0022-3514.88.6.999 Hatzigeorgiadis, A., Morela, E., Elbe, A.-M., Kouli, O., & Sanchez, X. (2013). The integrative role of sport in multicultural societies. European Psychologist, 18(3), 191–202. https://doi.org/10.1027/1016-9040/a000155 International Olympic Committee. (2020). Olympic Charter. International Olympic Committee. https://stillmed.olympic.org/media/Document%20Library/OlympicOrg/General/EN-Olympic-Charter.pdf Jonas, E., Kayser, D., Martens, A., Fritsche, I., Sullivan, D., & Greenberg, J. (2008). Focus theory of normative conduct and terror-management theory: The interactive impact of mortality salience and norm salience on social judgment. Journal of Personality and Social Psychology, 95(6), 1239-1251. https://doi.org/10.1037/a0013593 Judd, C. M., Mcclelland, G., & Ryan, C. S. (2017). Data analysis: A model comparison approach to regression, ANOVA, and beyond. Routledge. Koh, K. T., Ong, S. W., & Camiré, M. (2016). Implementation of a values training program in physical education and sport: Perspectives from teachers, coaches, students, and athletes. Physical Education and Sport Pedagogy, 21(3), 295-312. https://doi.org/10.1080/17408989.2014.990369 Louis, W. R., Chan, M. K.-H., & Greenbaum, S. (2009). Stress and theory of planned behavior: Understanding healthy and unhealthy eating intentions. Journal of Applied Social Psychology, 39(2), 472-493. https://doi.org/10.1111/j.1559-1816.2008.00447.x Miller, P. H., Baxter, S. D., Hitchcock, D. B., Royer, J. A., Smith, A. F., & Guinn, C. H. (2014). Test-retest reliability of a short form of the children’s social desirability scale for nutrition and health-related research. Journal of Nutrition Education and Behavior, 46(5), 423–428. https://doi.org/10.1016/j.jneb.2013.11.002 Schwartz, S. H. (2011). Values: Cultural and individual. In F. J. R. van de Vijver, A. Chasiotis & S. M. Breugelmans (Eds.), Fundamental questions in cross-cultural psychology (pp. 463–493). Cambridge University Press. https://doi.org/10.1017/CBO9780511974090.019 Swann Jr., W. B., Gómez, A., Huici, C., Morales, J., & Hixon, J. G. (2010). Identity fusion and self-sacrifice: Arousal as a catalyst of pro-group fighting, dying, and helping behavior. Journal of Personality and Social Psychology, 99(5), 824. https://doi.org/10.1037/a0020014 United Nations Educational, Scientific and Cultural Organization. (2016). The Incheon Declaration for Education 2030. Whitehead, J., Telfer, H., & Lambert, J. (Eds.). (2013). Values in youth sport and physical education. London: Routledge.
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QUEIROZ, MARIA GABRIELA DE, Thieres George Freire da Silva, Sérgio Zolnier, Sérvulo Mercier Siqueira e. Silva, Carlos André Alves de Souza, and Herica Fernanda de Sousa Carvalho. "RELAÇÕES HÍDRICO-ECONÔMICAS DA PALMA FORRAGEIRA CULTIVADA EM AMBIENTE SEMIÁRIDO." IRRIGA 1, no. 01 (June 18, 2018): 141. http://dx.doi.org/10.15809/irriga.2016v1n01p141-154.

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RELAÇÕES HÍDRICO-ECONÔMICAS DA PALMA FORRAGEIRA CULTIVADA EM AMBIENTE SEMIÁRIDO MARIA GABRIELA DE QUEIROZ1; THIERES GEORGE FREIRE DA SILVA2; SÉRGIO ZOLNIER3; SÉRVULO MERCIER SIQUEIRA E SILVA4; CARLOS ANDRÉ ALVES DE SOUZA5 E HERICA FERNANDA DE SOUSA CARVALHO6 1Doutoranda em Meteorologia Aplicada, Departamento de Engenharia Agrícola, Universidade Federal de Viçosa, mg.gabi@hotmail.com2Professor Adjunto IV, Unidade Acadêmica de Serra Talhada, Universidade Federal Rural de Pernambuco, thieres@pq.cnpq.br3Professor Titular, Departamento de Engenharia Agrícola, Universidade Federal de Viçosa, zolnier@ufv.br4Pesquisador, Instituto Agronômico de Pernambuco, servulo.siqueira@ipa.br5Mestrando do Programa de Pós-graduação em Produção Vegetal, Unidade Acadêmica de Serra Talhada, Universidade Federal Rural de Pernambuco, carlosandre08_@msn.com6Mestranda do Programa de Pós-graduação em Engenharia Agrícola, Universidade Federal do Vale do São Francisco, hericafernanda_17@hotmail.com 1 RESUMO Objetivou-se determinar índices hídrico-econômicos da palma forrageira irrigada no Semiárido brasileiro. O experimento foi conduzido em Serra Talhada, PE. O delineamento foi em blocos ao acaso, com cinco tratamentos baseados na evapotranspiração de referência e quatro repetições. Os dados do balanço de água no solo (BAS) e produtivos foram usados no cálculo de indicadores hídricos e econômicos para a cultura. Em relação aos componentes do BAS, apenas a variação do armazenamento de água revelou diferença entre os tratamentos (p < 0,05). A evapotranspiração e coeficiente da cultura apresentaram valores médios de 2,59 mm dia-1 e 0,52, nessa ordem, totalizando 985,77 mm no ciclo. As eficiências do uso de água evapotranspirada em base fresca e seca foram, em média, de 14,02 kg MV m-3 e 0,87 kg MS m-3, respectivamente. A produtividade econômica da água indicou um retorno econômico bruto de 5,50 dólares para cada m-3 de água fornecida à cultura (precipitação + irrigação), e de 6,18 US$ m-3, com base na evapotranspiração. A produtividade econômica da terra na venda de cladódios para semente e forragem (13.340 US$ ha-1e 6.000 US$ ha-1, nessa ordem) foram maiores aos relatos na literatura para outras culturas. Palavras-Chave: Coeficiente de cultura, Eficiência do uso da água, Evapotranspiração da cultura, Viabilidade econômica bruta QUEIROZ, M. G.; SILVA, T. G. F.; ZOLNIER, S.; SIQUEIRA E SILVA, S. M.; SOUZA, C. A. A.; CARVALHO, H. F. S HYDRO-ECONOMIC RELATIONS OF FORAGE CACTUS CULTIVATED IN SEMIARID ENVIRONMENT 2 ABSTRACT This study aimed to determine hydro-economic indices of cactus forage irrigated in the Brazilian Semiarid. The experiment was conducted in Serra Talhada, State of Pernambuco. The design was a randomized block with five treatments based on reference evapotranspiration in four replications. Soil water balance (SWB) and productive data were used in the calculation of water and economic indicators for crop. Regarding the components of the SWB, only the soil water storage variation revealed differences between treatments (p < 0,05). The evapotranspiration and crop coefficient showed values equal to 2.59 mm day-1 and 0.52, in that order, totaling 985.77 mm for the cycle. The evapotranspired water use efficiencies on fresh and dry basis were on averaged, 14.02 kg GM m-3 and 0.87 kg DM m-3, respectively. The water economic productivity indicated a gross economic return of 5.50 dollars for each m-3 of water supplied to the culture (rain + irrigation) and $ 6.18 m-3 dollars, based on the evapotranspiration. The land economic productivity for sale of cladode for seed and forage ($13,340 ha-1e $ 6,000 ha-1, in that order) were higher than in reports for other crops. Keywords: Crop coefficient, Water use efficiency, Crop evapotranspiration, Brute economic viability.
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Feland, Natalie, Aaron Mark Wendelboe, Micah Denay McCumber, Kai Ding, Dale Bratzler, Nimia Reyes, Michele Beckman, and Gary E. Raskob. "Hospital Associated Venous Thromboembolism in Oklahoma County." Blood 128, no. 22 (December 2, 2016): 416. http://dx.doi.org/10.1182/blood.v128.22.416.416.

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Abstract Introduction: Venous thromboembolism (VTE) is a leading cause of death and disability of the adverse outcomes associated with a hospital stay among low, middle, and high income countries evaluated by the WHO Patient Safety Program. Objective: Compare characteristics and risk factors for hospital associated and non-hospital associated cases of VTE in Oklahoma County from April 1, 2012 to March 31, 2014. Methods: In collaboration with the Centers for Disease Control and Prevention (CDC), a population-based surveillance system for VTE was established in Oklahoma County, OK between April 1, 2012-March 31, 2014 to estimate the incidences of first-time and recurrent VTE events. The Commissioner of Health made VTE a reportable condition and delegated surveillance-related responsibilities to the University of Oklahoma, College of Public Health. Active surveillance involved reviewing imaging studies (e.g., chest computed tomography and compression ultrasounds of the extremities) from all inpatient and outpatient facilities in the county and collecting demographic, treatment and risk factor data on all VTE case-patients. Hospital associated VTE is defined as a VTE diagnosis made either during the hospital stay or within 90 days of hospital admission, regardless of the reason for hospitalization. Odds ratios and 95% confidence intervals (CI) were calculated. Those age 80+ years were used as the referent age group. Comparisons between hospital associated and non-hospital associated VTE cases were made by using two-sided χ2tests. Results: We identified 2,737 patients with imaging-confirmed VTE. Of these, 1,223 (44.7%) cases were identified as hospital associated and 1,514 (55.3%) cases as non-hospital associated VTE. Of the hospital associated VTE cases, 863 (70.6%) had VTE diagnosed while hospitalized and 360 (29.4%) were diagnosed VTE as outpatients after hospital discharge; of these 360 cases, 239 (66.4%) were re-admitted to the hospital and 121 (33.6%) were managed as outpatients. Of the non-hospital associated VTE cases, 776 (51.3%) were admitted to the hospital after diagnosis and 738 (48.7%) were treated as outpatients. The median length of stay for hospital-associated cases was 8 days (range 1-206 days). The distribution of PE (p = 0.17) and DVT (p = 0.07) were similar in hospital associated cases and non-hospital associated cases. The distributions of race (p = 0.34) and sex (p = 0.17) were similar for patients with and without hospital associated VTE; however, hospital associated cases of VTE tended to be older than non-hospital associated cases (p<0.01; 18-39 years OR = 1.7, 95% CI 1.2-2.2, 40-49 years OR = 1.8, 95% CI 1.3-2.4, 50-59 years OR = 1.3, 95% CI 1.0-1.7, 60-69 years OR = 1.1, 95% CI 0.84-1.4, 70-79 years OR = 1.2, 95% CI 0.91-1.5). Venous catheterization in the last 6 months (OR= 4.4, 95% CI 3.4-5.7), surgery (OR = 3.4, 95% CI 2.8-4.0) and trauma (OR = 3.0, 95% CI 2.3-3.9) in the last 12 months, and histories of: congestive heart failure (OR = 2.6, 95% CI 2.0-3.3), stroke (OR = 2.6, 95% CI 1.9-3.6), myocardial infarction (OR = 2.2, 95% CI 1.6-3.1), superficial vein thrombosis (OR = 1.8, 95% CI 1.3-2.5), and cancer (OR = 1.5, 95% CI 1.3-1.8) were risk factors for hospital associated cases of VTE. Hospital associated VTE cases had 3.5 times the odds of death (95% CI 2.4-5.0) than non-hospital associated cases. Discussion: A significant proportion (45%) of the total VTE burden continues to be hospital associated. A substantial proportion of hospital associated cases are diagnosed after discharge and result in re-admission, with the potential for significant financial penalties under Medicare value-based payment programs. Hospital associated cases of VTE were older, had more risk factors, and were more likely to die than non-hospital associated cases. Disclosures Raskob: Bayer Healthcare: Consultancy; BMS: Consultancy; Daiichi Sankyo: Consultancy; Janssen Pharmaceuticals: Consultancy; Pfizer: Consultancy; ISIS Pharmaceuticals: Consultancy.
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VOLONTYR, Ludmila, Nadiya POTAPOVA, and Oksana ZELINSKA. "ECONOMETRIC MODELING IN FORMATION OF OPTIMAL PRICE FOR IMPLEMENTATION OF AGRICULTURAL PRODUCTS." "EСONOMY. FINANСES. MANAGEMENT: Topical issues of science and practical activity", no. 5 (45) (May 2019): 83–93. http://dx.doi.org/10.37128/2411-4413-2019-5-9.

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Ukraine is a predominantly agricultural country, and this branch has been recently demonstrating relatively high efficiency. Vegetable growing is a specific branch of crop production, which includes a large set of vegetables grown according to different technologies, with different shelf life of vegetable products, their different cost and production efficiency. The analysis of the situation on the vegetable market of Ukraine showed that there is a certain correlation between production volumes, sales and products sales prices. The price market environment on the vegetable market in recent years is largely determined by the ratio of supply and demand on the market. Thus, sales volumes increase when the supply on the market is the highest and the price level on the market is the lowest. The absence of permanent wholesale distribution channels also leads to an increase in the hidden market for vegetable products. According to experts of the Ukrainian Agrarian Confederation, the hidden market for fruit and vegetables is about $ 14 billion, or about 60% of the total turnover of vegetable products in Ukraine. Due to the moratorium on the sale of agricultural land, businesses are not able to buy land on their own and develop their business in the long-term prospects. Today, government support in the vegetable sector is limited to preferential lending and to individual funding programs, most often in collaboration with international donors. Much of the support for agro-industrial farms goes to grain and pulse plant producers, which significantly limits the opportunity for developing crop producers with higher marginality. The conditions in which the agrarian sector operates have a high degree of changeable uncertainty, and this circumstance requires agricultural producers to find ways to obtain reliable information about the state of the agricultural market, organizational and functional links between the subjects of the agricultural market, prices for agricultural products. etc. The purpose of this study is to: analyze the price of vegetable sales in Ukraine; substantiation of the use of the AGMEMOD partial equilibrium model for forecasting vegetable production in Ukraine; establish dependence of demand and supply of vegetable production on their sales price; determine the point of equilibrium of supply and demand and calculate of the optimal selling price of vegetables in Ukraine; justify the optimal costs for vegetable production; analyze of the price of selling vegetables in Ukraine and determine the optimal price according to supply and demand, as well as the optimal cost of vegetable production. Now, there are 12 key vegetable crops in Ukraine. These are potatoes, cucumbers, tomatoes, cabbage, beets, carrots, onions, garlic, peppers, zucchini, eggplants and pumpkin. Of these 12 cultures, 9 showed an increase in the period 2010-2016, even without taking into account the uncontrolled Crimea and Donbass. This increase has been driven by two crucial factors: - yield increase. This was made possible due to improving the quality of the seed and natural technological progress in the processing and the use of crop protecting agents. - increase in export demand for products. The demand, for example, for Ukrainian carrots and onions has increased, and therefore the opportunities for their cultivation have become greater. Price is a complex economic category, practically the only element of marketing that enables an enterprise to earn real income. Without proper economic justification of the price level, the normal functioning of economic entities and entire sectors of the economy is impossible, which in turn has a significant impact on the material well-being of the population. The level of market price depends on the value of other marketing elements, as well as on the level of competition on the market and the general state of the economy. As a rule, other marketing elements also change (for example, with increasing product differentiation in order to maximize price or at least the difference between price and cost). The price formation strategy allows determining the price level and marginal prices for individual product groups. The price formation should always be carried out taking into account the nomenclature and quality of products, their usefulness, importance and purchasing power of consumers and prices of the competitors. The strategy of price formation management is a set of measures to maintain conditional prices while actually regulating them in accordance with the variety and characteristics of demand, competition in the market. The AGMEMOD model is an example of the partial equilibrium (PE) models used in agriculture. The main advantages of partial equilibrium models are: the simplicity of the implemented algorithms, the operation of which is quite easily traced; relative availability of necessary data; the calculations are amenable to adequate economic interpretation, making it possible to quickly analyze the consequences of making a decision in the agricultural sector. However, partial equilibrium models are not without their disadvantages. In particular, they do not permit to assess macroeconomic effects such as changes in national income or employment levels, the effects that may be obtained from the redistribution of resources (labor, capital, etc.) into more efficient sectors. For national researchers, it is advisable to use these models, because they have a module of Ukraine, but it is necessary to supplement the program with statistics on vegetables. The demand is a function of price changes in the current period, and the supply is a function of price changes in previous periods. Econometric models of supply and demand dependence of vegetable production on the price of their sale are constructed. The equilibrium of the system is observed at the price of 6558 UAH. for 1 ton of vegetables under the given conditions of consumption, the demand is equal to supply and is 9321 thousand tons. Econometric models of price dependence on material costs, labor costs and depreciation have been constructed. By the first model, it can be determined that the content of unaccounted factors is estimated at 99.82 UAH. per hectare; with an increase in material costs by 1 hectare by 1 UAH, selling price increases by 0.9 UAH. per ton. Based on the Fisher's ratio test, the model is adequate, the relationship between the indicators is tight. The relationship between the indicators of the second model is weak, the calculated correlation coefficient can be trusted, but in general, the adequacy of the model conclusion cannot be made. The model shows that with an increase in labor costs by 1 UAH per hectare, the price increases by 10.03 UAH per ton. The third model based on the Fisher's ratio test is adequate, the relationship between the indicators is average. With the increase in depreciation costs per hectare by 1 UAH, the selling price will increase by 12.42 UAH per ton. The value of the linear correlation coefficient other than zero is statistically significant. Based on the calculated models, we will determine the optimal cost per hectare: material – 7144.2 UAH, labor costs – 689.4 UAH, depreciation costs – 543.4 UAH.
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Johnson, G., K. Hickey, A. Azin, K. Guidolin, K. Guidolin, F. Shariff, J. Gentles, et al. "2021 Canadian Surgery Forum01. Design and validation of a unique endoscopy simulator using a commercial video game03. Is ethnicity an appropriate measure of health care marginalization?: A systematic review and meta-analysis of the outcomes of diabetic foot ulceration in the Aboriginal population04. Racial disparities in surgery — a cross-specialty matched comparison between black and white patients05. Starting late does not increase the risk of postoperative complications in patients undergoing common general surgical procedures06. Ethical decision-making during a health care crisis: a resource allocation framework and tool07. Ensuring stability in surgical training program leadership: a survey of program directors08. Introducing oncoplastic breast surgery in a community hospital09. Leadership development programs for surgical residents: a review of the literature10. Superiority of non-opioid postoperative pain management after thyroid and parathyroid operations: a systematic review and meta-analysis11. Timing of ERCP relative to cholecystectomy in patients with ductal gallstone disease12. A systematic review and meta-analysis of randomized controlled trials comparing intraoperative red blood cell transfusion strategies13. Postoperative outcomes after frail elderly preoperative assessment clinic: a single-institution Canadian perspective14. Selective opioid antagonists following bowel resection for prevention of postoperative ileus: a systematic review and meta-analysis15. Peer-to-peer coaching after bile duct injury16. Laparoscopic median arcuate ligament release: a video abstract17. Retroperitoneoscopic approach to adrenalectomy19. Endoscopic Zenker diverticulotomy: a video abstract20. Variability in surgeons’ perioperative management of pheochromocytomas in Canada21. The contribution of surgeon and hospital variation in transfusion practice to outcomes for patients undergoing elective gastrointestinal cancer surgery: a population-based analysis22. Perioperative transfusions for gastroesophageal cancers: risk factors and short- and long-term outcomes23. The association between frailty and time alive and at home after cancer surgery among older adults: a population-based analysis24. Psychological and workplace-related effects of providing surgical care during the COVID-19 pandemic in British Columbia, Canada25. Safety of venous thromboembolism prophylaxis in endoscopic retrograde cholangiopancreatography: a systematic review26. Complications and reintervention following laparoscopic subtotal cholecystectomy: a systematic review and meta-analysis27. Synchronization of pupil dilations correlates with team performance in a simulated laparoscopic team coordination task28. Receptivity to and desired design features of a surgical peer coaching program: an international survey9. Impact of the COVID-19 pandemic on rates of emergency department utilization due to general surgery conditions30. The impact of the current COVID-19 pandemic on the exposure of general surgery trainees to operative procedures31. Association between academic degrees and research productivity: an assessment of academic general surgeons in Canada32. Laparoscopic endoscopic cooperative surgery (LECS) for subepithelial gastric lesion: a video presentation33. Effect of the COVID-19 pandemic on acute care general surgery at an academic Canadian centre34. Opioid-free analgesia after outpatient general surgery: a pilot randomized controlled trial35. Impact of neoadjuvant immunotherapy or targeted therapies on surgical resection in patients with solid tumours: a systematic review and meta-analysis37. Surgical data recording in the operating room: a systematic review of modalities and metrics38. Association between nonaccidental trauma and neighbourhood socioeconomic status during the COVID-19 pandemic: a retrospective analysis39. Laparoscopic repair of a transdiaphragmatic gastropleural fistula40. Video-based interviewing in medicine: a scoping review41. Indocyanine green fluorescence angiography for prevention of anastomotic leakage in colorectal surgery: a cost analysis from the hospital payer’s perspective43. Perception or reality: surgical resident and faculty assessments of resident workload compared with objective data45. When illness and loss hit close to home: Do health care providers learn how to cope?46. Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial47. The evolving use of robotic surgery: a population-based analysis48. Prophylactic retromuscular mesh placement for parastomal hernia prevention: a retrospective cohort study of permanent colostomies and ileostomies49. Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: a retrospective cohort study on anastomotic complications50. A lay of the land — a description of Canadian academic acute care surgery models51. Emergency general surgery in Ontario: interhospital variability in structures, processes and models of care52. Trauma 101: a virtual case-based trauma conference as an adjunct to medical education53. Assessment of the National Surgical Quality Improvement Program Surgical Risk Calculator for predicting patient-centred outcomes of emergency general surgery patients in a Canadian health care system54. Sustainability of a narcotic reduction initiative: 1 year following the Standardization of Outpatient Procedure (STOP) Narcotics Study55. Barriers to transanal endoscopic microsurgery referral56. Geospatial analysis of severely injured rural patients in a geographically complex landscape57. Implementation of an incentive spirometry protocol in a trauma ward: a single-centre pilot study58. Impostor phenomenon is a significant risk factor for burnout and anxiety in Canadian resident physicians: a cross-sectional survey59. Understanding the influence of perioperative education on performance among surgical trainees: a single-centre experience60. The effect of COVID-19 pandemic on current and future endoscopic personal protective equipment practices: a national survey of 77 endoscopists61. Case report: delayed presentation of perforated sigmoid diverticulitis as necrotizing infection of the lower limb62. Investigating disparities in surgical outcomes in Canadian Indigenous populations63. Fundoplication is superior to medical therapy for Barrett esophagus disease regression and progression: a systematic review and meta-analysis64. Development of a novel online general surgery learning platform and a qualitative preimplementation analysis65. Hagfish slime exudate as a potential novel hemostatic agent: developing a standardized assessment protocol66. The effect of the first wave of the COVID-19 pandemic on surgical oncology case volumes and wait times67. Safety of same-day discharge in high-risk patients undergoing ambulatory general surgery68. External validation of the Codman score in colorectal surgery: a pragmatic tool to drive quality improvement69. Improved morbidity and gastrointestinal restoration rates without compromising survival rates for diverting loop ileostomy with colonic lavage versus total abdominal colectomy for fulminant Clostridioides difficile colitis: a multicentre retrospective cohort study70. Potential access to emergency general surgical care in Ontario71. Immersive virtual reality (iVR) improves procedural duration, task completion and accuracy in surgical trainees: a systematic review01. Clinical validation of the Canada Lymph Node Score for endobronchial ultrasound02. Venous thromboembolism in surgically treated esophageal cancer patients: a provincial population-based study03. Venous thromboembolism in surgically treated lung cancer patients: a population-based study04. Is frailty associated with failure to rescue after esophagectomy? A multi-institutional comparative analysis of outcomes05. Routine systematic sampling versus targeted sampling of lymph nodes during endobronchial ultrasound: a feasibility randomized controlled trial06. Gastric ischemic conditioning reduces anastomotic complications in patients undergoing esophagectomy: a systematic review and meta-analysis07. Move For Surgery, a novel preconditioning program to optimize health before thoracic surgery: a randomized controlled trial08. In case of emergency, go to your nearest emergency department — Or maybe not?09. Does preoperative SABR increase the risk of complications from lung cancer resection? A secondary analysis of the MISSILE trial10. Segmental resection for lung cancer: the added value of near-infrared fluorescence mapping diminishes with surgeon experience11. Toward competency-based continuing professional development for practising surgeons12. Stereotactic body radiotherapy versus surgery in older adults with NSCLC — a population-based, matched analysis of long-term dependency outcomes13. Role of adjuvant therapy in esophageal cancer patients after neoadjuvant therapy and curative esophagectomy: a systematic review and meta-analysis14. Evaluation of population characteristics on the incidence of thoracic empyema: an ecological study15. Determining the optimal stiffness colour threshold and stiffness area ratio cut-off for mediastinal lymph node staging using EBUS elastography and AI: a pilot study16. Quality assurance on the use of sequential compression stockings in thoracic surgery (QUESTs)17. The relationship between fissureless technique and prolonged air leak for patients undergoing video-assisted thoracoscopic lobectomy18. CXCR2 inhibition as a candidate for immunomodulation in the treatment of K-RAS-driven lung adenocarcinoma19. Assessment tools for evaluating competency in video-assisted thoracoscopic lobectomy: a systematic review20. Understanding the current practice on chest tube management following lung resection among thoracic surgeons across Canada21. Effect of routine jejunostomy tube insertion in esophagectomy: a systematic review and meta-analysis22. Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: a retrospective analysis23. Surgical outcomes following chest wall resection and reconstruction24. Outcomes following surgical management of primary mediastinal nonseminomatous germ cell tumours25. Does robotic approach offer better nodal staging than thoracoscopic approach in anatomical resection for non–small cell lung cancer? A single-centre propensity matching analysis26. Competency assessment for mediastinal mass resection and thymectomy: design and Delphi process27. The contemporary significance of venous thromboembolism (deep venous thrombosis [DVT] and pulmonary embolus [PE]) in patients undergoing esophagectomy: a prospective, multicentre cohort study to evaluate the incidence and clinical outcomes of VTE after major esophageal resections28. Esophageal cancer: symptom severity at the end of life29. The impact of pulmonary artery reconstruction on postoperative and oncologic outcomes: a systematic review30. Association with surgical technique and recurrence after laparoscopic repair of paraesophageal hernia: a single-centre experience31. Enhanced recovery after surgery (ERAS) in esophagectomy32. Surgical treatment of esophageal cancer: trends in surgical approach and early mortality at a single institution over the past 18 years34. Adverse events and length of stay following minimally invasive surgery in paraesophageal hernia repair35. Long-term symptom control comparison of Dor and Nissen fundoplication following laparoscopic para-esophageal hernia repair: a retrospective analysis36. Willingness to pay: a survey of Canadian patients’ willingness to contribute to the cost of robotic thoracic surgery37. Radiomics in early-stage lung adenocarcinoma: a prediction tool for tumour immune microenvironments38. Effectiveness of intraoperative pyloric botox injection during esophagectomy: how often is endoscopic intervention required?39. An artificial intelligence algorithm for predicting lymph node malignancy during endobronchial ultrasound40. The effect of major and minor complications after lung surgery on length of stay and readmission41. Measuring cost of adverse events following thoracic surgery: a scoping review42. Laparoscopic paraesophageal hernia repair: characterization by hospital and surgeon volume and impact on outcomes43. NSQIP 5-Factor Modified Frailty Index predicts morbidity but not mortality after esophagectomy44. Trajectory of perioperative HRQOL and association with postoperative complications in thoracic surgery patients45. Variation in treatment patterns and outcomes for resected esophageal cancer at designated thoracic surgery centres46. Patient-reported pretreatment health-related quality of life (HRQOL) predicts short-term survival in esophageal cancer patients47. Analgesic efficacy of surgeon-placed paravertebral catheters compared with thoracic epidural analgesia after Ivor Lewis esophagectomy: a retrospective noninferiority study48. Rapid return to normal oxygenation after lung surgery49. Examination of local and systemic inflammatory changes during lung surgery01. Implications of near-infrared imaging and indocyanine green on anastomotic leaks following colorectal surgery: a systematic review and meta-analysis02. Repeat preoperative endoscopy after regional implementation of electronic synoptic endoscopy reporting: a retrospective comparative study03. Consensus-derived quality indicators for operative reporting in transanal endoscopic surgery (TES)04. Colorectal lesion localization practices at endoscopy to facilitate surgical and endoscopic planning: recommendations from a national consensus Delphi process05. Black race is associated with increased mortality in colon cancer — a population-based and propensity-score matched analysis06. Improved survival in a cohort of patients 75 years and over with FIT-detected colorectal neoplasms07. Laparoscopic versus open loop ileostomy reversal: a systematic review and meta-analysis08. Posterior mesorectal thickness as a predictor of increased operative time in rectal cancer surgery: a retrospective cohort study09. Improvement of colonic anastomotic healing in mice with oral supplementation of oligosaccharides10. How can we better identify patients with rectal bleeding who are at high risk of colorectal cancer?11. Assessment of long-term bowel dysfunction in rectal cancer survivors: a population-based cohort study12. Observational versus antibiotic therapy for acute uncomplicated diverticulitis: a noninferiority meta-analysis based on a Delphi consensus13. Radiotherapy alone versus chemoradiotherapy for stage I anal squamous cell carcinoma: a systematic review and meta-analysis14. Is the Hartmann procedure for diverticulitis obsolete? National trends in colectomy for diverticulitis in the emergency setting from 1993 to 201515. Sugammadex in colorectal surgery: a systematic review and meta-analysis16. Sexuality and rectal cancer treatment: a qualitative study exploring patients’ information needs and expectations on sexual dysfunction after rectal cancer treatment17. Video-based interviews in selection process18. Impact of delaying colonoscopies during the COVID-19 pandemic on colorectal cancer detection and prevention19. Opioid use disorder associated with increased anastomotic leak and major complications after colorectal surgery20. Effectiveness of a rectal cancer education video on patient expectations21. Robotic-assisted rectosigmoid and rectal cancer resection: implementation and early experience at a Canadian tertiary centre22. An online educational app for rectal cancer survivors with low anterior resection syndrome: a pilot study23. The effects of surgeon specialization on the outcome of emergency colorectal surgery24. Outcomes after colorectal cancer resections in octogenarians and older in a regional New Zealand setting — What are the predictors of mortality?25. Long-term outcomes after seton placement for perianal fistulae with and without Crohn disease26. A survey of patient and surgeon preference for early ileostomy closure following restorative proctectomy for rectal cancer — Why aren’t we doing it?27. Crohn disease independently associated with longer hospital admission after surgery28. Short-stay (≤ 1 d) diverting loop ileostomy closure can be selectively implemented without an increase in readmission and complication rates: an ACS-NSQIP analysis29. A comparison of perineal stapled rectal prolapse resection and the Altemeier procedure at 2 Canadian academic hospitals30. Mental health and substance use disorders predict 90-day readmission and postoperative complications following rectal cancer surgery31. Early discharge after colorectal cancer resection: trends and impact on patient outcomes32. Oral antibiotics without mechanical bowel preparation prior to emergency colectomy reduces the risk of organ space surgical site infections: a NSQIP propensity score matched study33. The impact of robotic surgery on a tertiary care colorectal surgery program, an assessment of costs and short-term outcomes — a Canadian perspective34. Should we scope beyond the age limit of guidelines? Adenoma detection rates and outcomes of screening and surveillance colonoscopies in patients aged 75–79 years35. Emergency department admissions for uncomplicated diverticulitis: a nationwide study36. Obesity is associated with a complicated episode of acute diverticulitis: a nationwide study37. Green indocyanine angiography for low anterior resection in patients with rectal cancer: a prospective before-and-after study38. The impact of age on surgical recurrence of fibrostenotic ileocolic Crohn disease39. A qualitative study to explore the optimal timing and approach for the LARS discussion01. Racial, ethnic and socioeconomic disparities in diagnosis, treatment and survival of patients with breast cancer: a SEER-based population analysis02. First-line palliative chemotherapy for esophageal and gastric cancer: practice patterns and outcomes in the general population03. Frailty as a predictor for postoperative outcomes following pancreaticoduodenectomy04. Synoptic electronic operative reports identify practice variation in cancer surgery allowing for directed interventions to decrease variation05. The role of Hedgehog signalling in basal-like breast cancer07. Clinical and patient-reported outcomes in oncoplastic breast conservation surgery from a single surgeon’s practice in a busy community hospital in Canada08. Upgrade rate of atypical ductal hyperplasia: 10 years of experience and predictive factors09. Time to first adjuvant treatment after oncoplastic breast reduction10. Preparing to survive: improving outcomes for young women with breast cancer11. Opioid prescription and consumption in patients undergoing outpatient breast surgery — baseline data for a quality improvement initiative12. Rectal anastomosis and hyperthermic intraperitoneal chemotherapy: Should we avoid diverting loop ileostomy?13. Delays in operative management of early-stage, estrogen-receptor positive breast cancer during the COVID-19 pandemic — a multi-institutional matched historical cohort study14. Opioid prescribing practices in breast oncologic surgery15. Oncoplastic breast reduction (OBR) complications and patient-reported outcomes16. De-escalating breast cancer surgery: Should we apply quality indicators from other jurisdictions in Canada?17. The breast cancer patient experience of telemedicine during COVID-1918. A novel ex vivo human peritoneal model to investigate mechanisms of peritoneal metastasis in gastric adenocarcinoma (GCa)19. Preliminary uptake and outcomes utilizing the BREAST-Q patient-reported outcomes questionnaire in patients following breast cancer surgery20. Routine elastin staining improves detection of venous invasion and enhances prognostication in resected colorectal cancer21. Analysis of exhaled volatile organic compounds: a new frontier in colon cancer screening and surveillance22. A clinical pathway for radical cystectomy leads to a shorter hospital stay and decreases 30-day postoperative complications: a NSQIP analysis23. Fertility preservation in young breast cancer patients: a population-based study24. Investigating factors associated with postmastectomy unplanned emergency department visits: a population-based analysis25. Impact of patient, tumour and treatment factors on psychosocial outcomes after treatment in women with invasive breast cancer26. The relationship between breast and axillary pathologic complete response in women receiving neoadjuvant chemotherapy for breast cancer01. The association between bacterobilia and the risk of postoperative complications following pancreaticoduodenectomy02. Surgical outcome and quality of life following exercise-based prehabilitation for hepatobiliary surgery: a systematic review and meta-analysis03. Does intraoperative frozen section and revision of margins lead to improved survival in patients undergoing resection of perihilar cholangiocarcinoma? A systematic review and meta-analysis04. Prolonged kidney procurement time is associated with worse graft survival after transplantation05. Venous thromboembolism following hepatectomy for colorectal metastases: a population-based retrospective cohort study06. Association between resection approach and transfusion exposure in liver resection for gastrointestinal cancer07. The association between surgeon volume and use of laparoscopic liver resection for gastrointestinal cancer08. Immune suppression through TIGIT in colorectal cancer liver metastases09. “The whole is greater than the sum of its parts” — a combined strategy to reduce postoperative pancreatic fistula after pancreaticoduodenectomy10. Laparoscopic versus open synchronous colorectal and hepatic resection for metastatic colorectal cancer11. Identifying prognostic factors for overall survival in patients with recurrent disease following liver resection for colorectal cancer metastasis12. Modified Blumgart pancreatojejunostomy with external stenting in laparoscopic Whipple reconstruction13. Laparoscopic versus open pancreaticoduodenectomy: a single centre’s initial experience with introduction of a novel surgical approach14. Neoadjuvant chemotherapy versus upfront surgery for borderline resectable pancreatic cancer: a single-centre cohort analysis15. Thermal ablation and telemedicine to reduce resource utilization during the COVID-19 pandemic16. Cost-utility analysis of normothermic machine perfusion compared with static cold storage in liver transplantation in the Canadian setting17. Impact of adjuvant therapy on overall survival in early-stage ampullary cancers: a single-centre retrospective review18. Presence of biliary anaerobes enhances response to neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma19. How does tumour viability influence the predictive capability of the Metroticket model? Comparing predicted-to-observed 5-year survival after liver transplant for hepatocellular carcinoma20. Does caudate resection improve outcomes in patients undergoing curative resection for perihilar cholangiocarcinoma? A systematic review and meta-analysis21. Appraisal of multivariable prognostic models for postoperative liver decompensation following partial hepatectomy: a systematic review22. Predictors of postoperative liver decompensation events following resection in patients with cirrhosis and hepatocellular carcinoma: a population-based study23. Characteristics of bacteriobilia and impact on outcomes after Whipple procedure01. Inverting the y-axis: the future of MIS abdominal wall reconstruction is upside down02. Progressive preoperative pneumoperitoneum: a single-centre retrospective study03. The role of radiologic classification of parastomal hernia as a predictor of the need for surgical hernia repair: a retrospective cohort study04. Comparison of 2 fascial defect closure methods for laparoscopic incisional hernia repair01. Hypoalbuminemia predicts serious complications following elective bariatric surgery02. Laparoscopic adjustable gastric band migration inducing jejunal obstruction associated with acute pancreatitis: aurgical approach of band removal03. Can visceral adipose tissue gene expression determine metabolic outcomes after bariatric surgery?04. Improvement of kidney function in patients with chronic kidney disease and severe obesity after bariatric surgery: a systematic review and meta-analysis05. A prediction model for delayed discharge following gastric bypass surgery06. Experiences and outcomes of Indigenous patients undergoing bariatric surgery: a mixed-methods scoping review07. What is the optimal common channel length in revisional bariatric surgery?08. Laparoscopic management of internal hernia in a 34-week pregnant woman09. Characterizing timing of postoperative complications following elective Roux-en-Y gastric bypass and sleeve gastrectomy10. Canadian trends in bariatric surgery11. Common surgical stapler problems and how to correct them12. Management of choledocholithiasis following Roux-en-Y gastric bypass: a systematic review and meta-analysis." Canadian Journal of Surgery 64, no. 6 Suppl 2 (December 14, 2021): S80—S159. http://dx.doi.org/10.1503/cjs.021321.

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Patterson, Megan S., Christina Amo, Allison N. Francis, Katie M. Heinrich, Tyler Prochnow, Jocelyn Hunyadi, and Sydney Miller. "The importance of social connections in combating compulsive exercise among group-exercise participants: a network analysis." Mental Health and Social Inclusion, July 25, 2022. http://dx.doi.org/10.1108/mhsi-03-2022-0016.

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Purpose This paper aims to use social network analysis (SNA) to determine whether compulsive exercise (CE) was related to social connections and network position among participants of group-exercise programs. Design/methodology/approach Members from two group-exercise programs (Gym 1: n = 103; Gym 2: n = 56) completed an online survey measuring their social connections within the program, CE, depressive symptoms and sense of belonging. Network position was calculated for each person based on network centrality scores (i.e. closeness, eigenvector centrality). Linear network autocorrelation models determined whether respondents reported similar CE as their network ties (i.e., network effects) and whether network position was related to CE in these networks. Findings Eigenvector centrality (i.e., being connected to popular/important people within the network; Gym 1: parameter estimate [PE] = 0.51, p < 0.01, Gym 2: PE = 0.39, p = 0.02) and network effects (i.e. having similar CE scores as direct network ties; Gym 1: PE = 0.07, p < 0.01, Gym 2: PE = 0.19, p < 0.01) were related to CE among participants in these programs. Originality/value This study builds on existing SNA research suggesting the importance of social connections and network position on CE, and, to the best of the authors’ knowledge, is the first to explore these effects among group-exercise participants. This study describes how the social environment can impact, both positively and negatively, someone’s susceptibility for CE and supports fostering social connections within group-exercise programs as a way to potentially combat harmful CE among its participants.
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Mohr, Katharina, Philipp Mildenberger, Luca Valerio, Klaus Kaier, Konstantinos Christodoulou, Ioannis T. Farmakis, Stefano Barco, Irene Schmidtmann, Harald Binder, and Stavros V. Konstantinides. "Abstract 15055: Annual Healthcare Costs After Acute Pulmonary Embolism: Results From a Prospective Multicenter Cohort Study." Circulation 148, Suppl_1 (November 7, 2023). http://dx.doi.org/10.1161/circ.148.suppl_1.15055.

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Introduction: Analysis of administrative data has helped to determine hospitalization costs related to acute pulmonary embolism (PE) in several countries, but estimating long-term costs of patient care after discharge is a more challenging task. Aims: To determine the direct annual costs related to the care of PE survivors based on data from a longitudinal cohort study performed at 17 German large-volume hospitals. Methods: The Follow-up of Acute Pulmonary Embolism (FOCUS) study enrolled unselected patients with acute PE. In addition to a structured ambulatory follow-up (FU) program (Figure) , we prospectively recorded duration and type of anticoagulation and the main and accompanying causes of all rehospitalizations during the first year of FU. Annual per-patient costs of post-PE care were calculated in 2022 euro (є) and converted to US$ adjusting for purchase parity power. Results: A total of 1,017 patients (45% women; median age 64 years [IQR, 52-74]) were included. Average costs of scheduled ambulatory FU visits and tests were estimated at є136.37 ($189.40) per patient; costs of oral anticoagulation after hospital discharge for the index event amounted to є827.72 ($1,149.61). The annual all-cause hospitalization rate was 31.96% (95% CI, 28.0-35.91%); the Table shows the primary indications and mean hospital costs (overall, and per indication). Of the є1,104.48 ($1,534.0) average rehospitalization costs per patient, 8.9% were related to recurrent thrombosis/PE or bleeding. Conclusions: Our results, derived from the population of a prospective multicenter study, help to dissect the direct annual costs of chronic post-PE care and may inform ambulatory care programs.
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Farmakis, I., L. Valerio, A. C. Mavromanoli, B. Bikdeli, J. M. Connors, G. Giannakoulas, S. Z. Goldhaber, et al. "Mortality related to pulmonary embolism in the United States before and during the COVID-19 pandemic: an analysis of the CDC Multiple Cause of Death database." European Heart Journal 43, Supplement_2 (October 1, 2022). http://dx.doi.org/10.1093/eurheartj/ehac544.1869.

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Abstract Background The COVID-19 pandemic caused a large number of excess deaths. COVID-19 emerged as a prothrombotic disease often complicated by pulmonary embolism (PE). In light of this, we hypothesized that PE-related mortality rates (stable before the pandemic) would be characterized by an increasing trend following the COVID-19 outbreak. Purpose To investigate the mortality rates associated with PE among deaths with or without COVID-19 during the 2020 pandemic in the United States (US). Methods For this retrospective epidemiological study, we analyzed public medically certified vital registration data (death certificates encompassing underlying and multiple causes of death) from the Mortality Multiple Cause-of-Death database provided by the Division of Vital Statistics of the US Centers for Disease Control and Prevention (CDC; US, 2018–20). We investigated the time trends in monthly PE-related crude mortality rates for 2018–2019 and for 2020 (the latter associated vs. not associated with COVID-19), utilizing annual national population totals from the US Census Bureau. Second, we calculated the PE-related proportionate mortality among COVID-19 deaths (overall and limited to autopsy-based diagnosis). We performed subgroup analyses based on age groups, sex and race. Results During 2020, 49,423 deaths in association with PE were reported, vs. 39,450 in 2019 and 38,215 in 2018. The crude PE-related mortality rate without COVID-19 was 13.3 per 100,000 population in 2020 compared to 11.7 in 2018 and 12.0 in 2019 (Figure 1A). The PE-related mortality rate with COVID-19 was 1.6 per 100,000 population in 2020. Among non-COVID-19-related deaths, the crude PE-related mortality rate was higher in women; among COVID-19-related deaths, it was higher in men. PE-related mortality rates were approximately two-fold higher among black (vs. white) general population irrespective of COVID-19 status (Figures 1B and 1C). Among COVID-19 deaths, PE-related deaths corresponded to 1.4% of total; the value rose to 6.0% when an autopsy was performed. This figure was higher in men and its time evolution is depicted in Figure 2A. The proportionate mortality of PE in COVID-19 deaths was higher for younger age groups (15–44 years) compared to non-COVID-19-related deaths (Figure 2B). Conclusion In 2020, an overall 20%-increase in PE-related mortality was reported, not being limited to patients with COVID-19. Our findings could be interpreted in the context of undiagnosed COVID-19 cases, uncounted late sequelae, and possibly sedentary lifestyle and avoidance of healthcare facilities during the pandemic that may have prevented timely diagnosis and treatment of other diseases. Whether vaccination programs had an impact on PE-associated mortality in the year 2021, remains to be determined. Funding Acknowledgement Type of funding sources: None.
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Thangirala, Avinash, Yindalon Aphinyanaphongs, Ji Chen, Jacob A. Martin, Usman Alam, Nehal Dhaduk, Andrew C. Kelleher, et al. "Abstract 15199: Automated Machine Learning (AutoML) Algorithms to Predict Post-Operative Venous Thromboembolism (VTE) Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Database." Circulation 146, Suppl_1 (November 8, 2022). http://dx.doi.org/10.1161/circ.146.suppl_1.15199.

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Introduction: Post-operative patients are at increased risk for venous thromboembolism (VTE). Given the morbidity and mortality associated with VTE, risk stratification calculators have been developed based on pre-operative patient characteristics. Most risk calculators rely on logistic regression (LR) analysis. However, automated machine learning (AutoML) programs consistently outperform standard LR models in non-medical contexts. This study aims to investigate the utility of novel methods in developing a model for post-operative VTE after non-cardiac and cardiac surgeries. Hypothesis: We hypothesized that AutoML models would be superior to logistic regression models in predicting post-operative VTE. Methods: We used an AutoML system developed and released by Amazon in 2020, AutoGluon v0.3.1, to predict post-operative VTE using the 2016-2018 ACS NSQIP database. A total of 3,049,617 patients and 79 pre-operative variables were included. Post-operative VTE was defined as a deep venous thrombosis (DVT) or a pulmonary embolism (PE) within 30 days of the surgery. Models were trained for four hours to optimize performance on the Brier score, with lower being better. Validation of all performance metrics was done using the 2019 ACS NSQIP database. Results: 0.79% of the patients (n = 23,974) developed post-operative VTE. Brier scores were calculated for each model with the top performing model being an ensembled neural net model having a Brier score of 0.00758 on the validation set. The corresponding AUROC and AUC-PR was 0.784 and 0.035 respectively (Figure). Conclusions: The models generated via AutoML to predict post-operative VTE had similar discriminatory characteristics to those reported in the literature. Future post-operative VTE models may benefit from AutoML analysis.
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Ponce, Rafael, Patrick Kinsella, and Darien Campbell. "1425. "Influence of outpatient antibiotic prescriptions in prevalence of ESBL producing Enterobacteriaceae in local hospitals"." Open Forum Infectious Diseases 10, Supplement_2 (November 27, 2023). http://dx.doi.org/10.1093/ofid/ofad500.1262.

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Abstract Background The increase in antibiotic resistance has been linked to antibiotic exposure. However, initiatives of antibiotic stewardship programs have been associated with decrease in antibiotic utilization but without a clear decrease in antibiotic resistance. We hypothesized that outpatient antibiotic exposure in communities geographically close to hospitals contribute to their incidence of ESBL producing Enterobacteriaceae (ESBL-PE). Outpatient antibiotic prescriptions per 1000 population by zip code Total antibiotic prescriptions per zip code Methods From March 2022 to March 2023 we evaluated antibiotic utilization in the inpatient and outpatient setting of a healthcare system in central Georgia. Outpatient settings included urgent cares, emergency rooms, and primary care clinics. The incidence of ESBL-PE was obtained from each hospital’s antibiogram. We calculated the number of outpatient prescriptions per zip code. Nearest neighbor analysis was used to determine the closest hospital for each zip code, with each zip code having a unique "nearest" hospital. The number of antibiotic prescriptions for those zip codes were assigned to that hospital. To estimate the antibiotic “burden” for each hospital, we used days of therapy (DOT) per 1000 days present of inpatient antibiotic use, plus antibiotic prescriptions per zip code population. Percentage of ESBL-PE for each hospital was the independent variable. QGIS v3.8 was used for spatial analysis. Inpatient antibiotic use and ESBL-PE percentage Outpatient antibiotic use Results There were 61 070 outpatient antibiotic prescriptions and 500 092 DOT. Prescriptions were given to residents of over 1000 different zip codes of nearly 20 states. 60% of the prescriptions were from urgent care centers, 1 for every 2 encounters. Inpatient antibiotic use varied among hospitals, with no correlation between antibiotic use and percentage of ESBL-PE. Linear regression model had an R2 of over 0.8 although with a p-value of 0.8. Conclusion The geographic reach of outpatient antibiotic prescriptions is of concern. The burden in their surrounding communities could be contributing to antibiotic resistance in hospitals, explaining the discrepancy of inpatient antibiotic use and antibiograms. Efforts to decrease antibiotic resistance should also include interventions in outpatient facilities. Our model didn’t reach statistical significance, likely due to the small hospital sample size, which we are currently evaluating. Disclosures All Authors: No reported disclosures
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Llorente-Alonso, Marta, Cristina García-Ael, and Gabriela Topa. "A meta-analysis of psychological empowerment: Antecedents, organizational outcomes, and moderating variables." Current Psychology, February 28, 2023. http://dx.doi.org/10.1007/s12144-023-04369-8.

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Abstract Psychological empowerment (PE) is a subjective, cognitive and attitudinal process that helps individuals feel effective, competent and authorized to carry out tasks. Over the last twenty years, research into PE has reported strong evidence reaffirming its role as a motivational factor in organizational psychology. In this study, the aim is to systematically review, analyze and quantify correlational empirical research focusing on empowerment, as understood by the theory developed by Spreitzer et al. (1995a, b), using meta-analytical techniques. The study also analyses the antecedents and consequences of PE and explores potential moderators of the relationship between this variable and its correlates. The electronic search encompassed studies dating from the publication of Spreitzer's empowerment scale (Academy of Management Journal, 38, 1442–1465, 1995b) up to January 2019. It was conducted in database aggregators, as well as in Metabus, occupational psychology journals and doctoral thesis repositories. Of the 1110 records identified, 94 were included in the meta-analysis. Most of the studies included used purposive or convenience sampling and had a cross-sectional study design. We focused on searching for studies that use a survey analysis approach. We extracted information about effect size (ES) in the associations between PE and its antecedents and consequences, and used the Comprehensive Meta-analysis 2.0 program to carry out the analyses (Borenstein et al., 2005). Effect size was calculated as the Pearson correlation (r), processed using Fisher's Z transformation. A random effects model was used and heterogeneity was analyzed to detect moderator variables. In relation to antecedents, in all meta-analyses, non-significant results were found only for education (r = -.001, CI [-.06, .06]) and organizational rank (r = .10, CI [-.16, .36]). All meta-analyses focusing on the association between psychological empowerment and its consequences returned significant results. Job satisfaction (r = .50) and organizational commitment (r = .51) had the largest effect sizes. Our results suggest which factors may be more important for generating empowerment among employees in accordance with the profession in which they work and their culture of origin. The main novelty offered by our results is that they indicate that age moderates the relationship between empowerment and the majority of the antecedents studied, a finding not reported in other meta-analyses. The present meta-analysis may help encourage organizations to pay more attention to PE, focusing their efforts on improving or strengthening certain structures or factors. Empowerment initiatives or programs focused on employee well-being lead to a workplace in which people are motivated and have a sense of purpose. Our results allow us to recommend interventions that enhance and improve the antecedents of EP. Finally, the present meta-analysis may help encourage organizations to pay more attention to the antecedents and consequences of PE, focusing their efforts on improving or strengthening certain structures or factors.
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Puente-Maxera, Federico, Antonio Méndez-Giménez, and Diego Martínez de Ojeda. "Physical activity levels during a Sport Education season of games from around the world." European Physical Education Review, July 28, 2020, 1356336X2093959. http://dx.doi.org/10.1177/1356336x20939591.

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Sport Education is a curriculum model designed to provide all students with authentic sport experiences, regardless of their individual characteristics. Research showing the effectiveness of the model in promoting physical activity (PA) levels is still scant. In addition, interventions have mostly included invasion games as the main content, thus suggesting the need for exploring alternative game classifications. This study aimed to objectively analyze PA levels (sedentary, light, moderate, vigorous, and moderate-to-vigorous (MVPA)), counts, and metabolic equivalent of task (MET) amongst seventh-grade students after having participated in a Sport Education season (18 lessons) of games from around the world. A total of 71 seventh-grade students (mean age = 12.3 ± 0.50; boys, n = 38; girls, n = 33) from a secondary school in northern Spain participated in the study. ActiGraph GT3X accelerometers were utilized to measure PA, counts, and METS. Likewise, height and weight were measured, and body mass index was calculated. Across the entire season students averaged just over 64% of lesson time engaged in MVPA. Significant differences in relation to gender were only found in counts (higher in boys). In relation to the phases, preseason was shown to be the most active phase, significantly contributing to MVPA levels, as well as to counts, and METS. The programme could be considered to be an effective resource for the promotion of more equitable participation, since both girls and boys displayed similar MVPA levels, exceeding the recommended minimum levels for PE lessons.
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Salim, Hatem, Marko Mrkobrada, Khaled Shamseddin, and Benjamin Thomson. "Enhancing Internal Medicine Residents’ Royal College Exam Competency Using In-Training Written Exams within a Competency Based Medical Education Framework." Canadian Journal of General Internal Medicine 12, no. 1 (May 9, 2017). http://dx.doi.org/10.22374/cjgim.v12i1.181.

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Background: Canadian residency programs have adopted competency-based medical education, where time-based learning systems are replaced with core competency “milestones” that must be achieved before a student progresses. Assessment tools must be developed to predict performance prior to high-stakes milestones, so interventions can be targeted to improve performance.Objectives: 1. To characterize how well each of three practice written exams predicts passing the Canadian Internal Medicine Royal College (RC) exam. 2. To determine if writing practice exams is perceived to improve performance on the RC exam.Methods: Three 105-question multiple choice question exams were created from a range of internal medicine topics, and offered one month apart to 35 residents. Percentile ranks on each practice exam were compared to the result (pass/fail) on the RC exam. Surveys were completed within 1 month after the RC exam.Results: There were 35 residents invited to participate. Practice exams (PE) 1, 2, and 3 were taken by 33, 26, and 22 residents, for an exam participation rate of 94.3, 74.3, and 62.9%, respectively. Failure on the RC exam could be predicted by percentile ranking <15% on PE1 (OR 19.5, p=0.017) or PE2 (OR 63.0, p=0.006), and by percentile ranking <30% on PE1 (OR 28.8, p=0.003), PE2 (OR 24.0, p=0.010) or PE3 (OR 15.0, p=0.046). The survey was sent out to the 33 participants. Of those, the total number of respondents was 25, with a response rate of 75.5%. Survey takers agreed that practice written exams improved performance on the RC exam (18/25, 88%).Conclusions: Performance in the Canadian Internal Medicine RC Exam can be predicted by performance on any of three practice written exams. This tool can therefore identify trainees for whom additional resources should be invested, to prevent failure of a high-stakes milestone within the competency based medical education framework.RÉSUMÉContexte : Les programmes canadiens de résidence ont choisi de diffuser un enseignement médical axé sur les compétences dans lequel les systèmes d’apprentissage structurés en fonction du temps sont remplacés par des « jalons » liés aux compétences fondamentales que l’étudiant doit atteindre pour aller de l’avant. Il faut élaborer des outils d’évaluation pour prédire la probabilité de résultats escomptés par un étudiant avant que celui-ci ne se présente à certains événements dont les enjeux sont élevés. Ainsi, il devient possible d’intervenir de manière à améliorer les résultats escomptés.Objectifs : 1. Déterminer dans quelle mesure chacun des trois examens de pratique écrits prédit la réussite à l’examen du Collège royal des médecins et chirurgiens du Canada (CRMCC) en médecine interne; 2. Évaluer si le fait de se soumettre à des examens de pratique écrits est perçu comme un élément qui améliore les résultats à l’examen du CRMCC.Méthodologie : Trois examens écrits comportant chacun 105 questions à choix de réponses portant sur un éventail de sujets relatifs à la médecine interne ont été préparés et proposés à 35 résidents à intervalle d’un mois. Les rangs-centiles de chaque examen de pratique ont été comparés avec le résultat obtenu à l’examen du CRMCC (succès/échec). Les sondages ont été effectués dans le mois suivant l’examen du CRMCC.Résultats : Trente-cinq résidents ont été invités aux examens de pratique écrits (EP) 1, 2 et 3. La participation a été respectivement de 33, 26 et 22 résidents, soit de 94,3 %, 74,3 % et 62,9 %. L’échec à l’examen du CRMCC pouvait être prédit par un rang-centile < 15 % à l’EP1 (OR 19,5 et p = 0,017) ou à l’EP2 (OR 63,0 et p = 0,006) et un rang-centile < 30 % à l’EP1 (OR 28,8 et p = 0,003), à l’EP2 (OR 24,0 et p = 0,010) ou à l’EP3 (OR 15,0, et p = 0,046). Le sondage a été envoyé aux 33 participants. Le nombre total de répondants a été de 25, pour un taux de réponse de 75,5 %. La majorité des répondants (18/25, 88 %) sont d’avis que les examens de pratique écrits leur ont permis d’obtenir de meilleurs résultats à l’examen du CRMCC.Conclusions : Les résultats à l’examen du Collège royal des médecins et chirurgiens du Canada (CRMCC) en médecine interne peuvent être prédits par les résultats obtenus à l’un des examens de pratique écrits. Par conséquent, cet outil peut être utilisé dans le cadre de l’enseignement de la médecine axé sur les compétences pour identifier sur qui l’on devrait investir des ressources additionnelles en vue d’éviter un échec à cet événement aux enjeux élevés.Competency-based medical education (CBME) has generated increased attention over the last decade,1–3 and become entrenched within several national medical education frameworks including Canada.4 Proponents of CBME suggest that older medical education models focus on medical knowledge rather than skills, or higher order aspects of practice. 5 Focus on time spent in training can take away from the abilities acquired during that time frame.6 Furthermore, flexible time periods may be more efficient and focused, compared to time-based curriculum.3,6,7 In light of these advantages, the Royal College of Physicians and Surgeons of Canada (RCPSC) has committed to transform medical education to a CBME model for all residency programs by 2017.4While residency programs reorganize toward the CBME model, residents will still be required to perform oral and written exams. It is thus essential that CBME-based programs incorporate assessment tools to predict performance on high-stakes milestones, such as RC exams.We created three written PEs, and evaluated how well each predicted performance on a high-stakes milestone, the RCPSC Internal Medicine exam (RC exam). We also evaluated how well PE were perceived to improve performance on the same high-stakes milestone RC exam.METHODSSetting and ParticipantsThe RC exam contains both written and oral components. All residents sitting both components of the RC exam, within 12 months, who were post-graduate medical residents at Western University (London, Ontario, Canada), were invited to participate. The study was conducted in 2013-2014.Western University Health Sciences Research Ethics Board provided an ethics waiver for this study, since the study was performed as part of the standard operations of an educational program.Intervention: ExamsTwo authors (HS, BT) separately created multiple choice questions (MCQ) reflecting all areas of internal medicine, based on the Objectives of Training of the RC Internal Medicine exam. RC exam questions are not available for purchase, and examinees are forbidden to share RC exam questions. Therefore, PE content and question style was informed by questions purchased for American Board of Internal Medicine (ABIM) course reviews.8,9 MCQ creators had each completed the RC exam within 3 years, and were thus familiar with MCQ and exam format.All authors independently reviewed each PE question to assure quality of content, grammar, spelling, and syntax. Each PE covered all subspecialty areas within internal medicine, including allergy and immunology ( n=4), cardiology (n=13), dermatology (n=2), endocrinology (n=8), gastroenterology (n=10), hematology (n=10), infectious diseases (n=15), nephrology ( n=9), neurology (n=6), oncology (n=4), respiratory and critical care medicine (n=7), rheumatology ( n=14) and statistics (n=3). This topic allocation included 7 questions for JAMA Rational Clinical Exam, and 5 for interpretation of medical images (e. g., chest X-ray, electrocardiogram). PE size (105 questions) and length (3 hours) were chosen to reflect the RC exam.Each PE was offered at two separate times, to assure flexibility within ongoing clinical responsibilities. PE1, PE2, and PE3 were offered approximately 7, 6, and 5 months prior to RC exam, respectively. This timing was chosen so that trainees had sufficient time to improve their performance before the RC exam if a poor PE result was found.Examinees were provided a personalized report for each exam, within 7 days of completing the PE. The personalized report included the examinee’s overall mark, average within each subspecialty, and percentile rank within the entire cohort of examinees. Two separate 1-hour periods were available to review each PE results, with the questions and key, supervised by BT.Intervention: SurveyAll study participants were invited to participate in a survey. The survey assessed how well PE simulated the RC exam, whether the PE were recommended to the next year’s cohort of examinees, and whether the PE improved performance on the RC exam.Outcomes: ExamsEach study participant agreed to provide the RC exam result (“pass” or “fail”) once he or she had received it. Each candidates verbally communicated RC exam result was confirmed online 3 months after the RC exam results were reported (cpso.on.ca).Odds ratios were calculated. The adverse outcome was failure on the RC exam. Exposures evaluated included percentile rank < 15% and <30%. Odds ratios of infinity were prevented by adding 1 adverse outcome to any exposure group without any adverse outcomes; this was performed for 3 exposure groups, but did not impact whether statistical significance was attained. Results are detailed in Table 1.Outcome: SurveySurvey results were on a Likert Scale. The proportion of those respondents who agreed or disagreed were calculated.All data was analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0.RESULTSSetting and ParticipantsThere were 35 residents invited to participate, the total number of possible participants. PE1, PE2, and PE3 were taken by 33, 26, and 22 residents, for an exam participation rate of 94.3, 74.3, and 62.9%, respectively. The majority of invitees took 3 (n=17) or 2 ( n=14), while a minority took 1 (n=2) or 0 (n=2) practice exams.ExamsOf all examinees of the RC exam (n=35), 7 failed. RC exam pass rates were lower when PE1 percentile rank was lower than 15% (40.0 vs. 92.9%, p<0.001) or 30% (44.4 vs. 100%, p<0.004), when PE2 percentile rank was lower than 15% (0.0 vs. 100.0%, p <0.001) or 30% (42.9 vs. 100.0%, p=0.038), and when PE3 percentile rank was lower than 30% (50 vs. 93.75%, p=0.046) (Figure 1). Figure 1. License exam practice pass rate versus percentile rate (PR) on practice exams. Examinees were more likely to fail the RC exam if percentile rank was less than 15% (OR 19.5, p=0.017) or 30% (OR 28.8, p=0.003) in PE1, less than 15% (OR 63.0, p=0.006) or 30% (OR 24.0, p =0.010) in PE2, or less than 30% (OR 15.0, p=0.046) in PE3.SurveyOnly residents who had taken at least 1 practice exam were invited to participate. The survey was sent out to the 33 participants, the total number of possible participants. Of those, the total number of respondents was 25, with a response rate of 75.5%. Most survey respondents agreed that the PEs were an accurate simulation of the written component of the RC examination (20/25, 80%) (Figure 2A). Most survey respondents agreed that the PEs improved performance on the RC written examinations (18/25, 72%) (Figure 2B). Most survey respondents recommended future residents to take the PEs (22/25, 88%) (Figure 2C).DISCUSSIONWe describe the creation of a tool to assess performance on a high-stakes milestone examination, the RC exam. This tool is easy to create, affordable, and is administered on a voluntary basis with high uptake amongst candidates writing the RC exam. The assessment tool has been shown to predict performance well so that resources can be invested in those at risk for failing.There is a possibility that mere participation in the assessment tool itself improves performance on this high-stakes exam. There were insufficient numbers of study participants to determine a correlation between number of exams taken and pass rates. Even still, unwillingness to participate in the study may reflect a general unwillingness to prepare, which means the results would be confounded and correlative rather than causative. One way to look into this is to perform a randomized trial in which half of residents take the assessment tool and the other half doesn’t. Unfortunately, almost all invited residents were anxious to participate, rendering such a possible study impossible. On the other hand, exam takers were able to communicate usefulness of the exam and to provide feedback on how it might be improved for future years.As CBME develops and becomes entrenched, there will continue to be a need to prepare for knowledge based written exams. This exam will continue to be considered a core competency between the stages to transition to practice. Thus, tools are needed to assess exam competence. This study confirms that such tools can and should be developed to assure that trainees are prepared.Ideally, residents with low performance would be identified early enough to intervene to change the outcome. It is uncertain what the ideal time frame is or what the intervention should be. It is reasonable to assume that taking the examination earlier in their training may allow candidates to become aware of their performance and implications thereof and implement earlier changes in learning strategies. For example, in past years, candidates contacted their program directors to ease the clinical workload to allow more study time. Others sought counselling and mentorship from staff, while others were self-directed in their learning and became more motivated to study. On the other hand, poor performance on this formative examination could potentially discourage some residents from studying if they felt their studying was futile. Future research efforts should focus on identifying which intervention is optimal to modify exam performance.The failure rate of 20% on the RC exam the year the study was conducted was unusually high for the program; however, this allowed for a correlation to be established between the PEs and the RC exam. The PEs were able to identify all those who failed the RC exam. However, there were those who scored below the 30th percentile on the PEs and still passed the RC exam. It must be kept in mind that the purpose of these formative exams is to identify those at high risk of failure so they can receive remedial support and improve their chances of passing. Thus, it is possible that through increased remedial support, those candidates who did poorly on the in-training exam managed to pass the RC exam.Only 2 trainees chose to write none of the PEs. While both of these trainees ultimately failed the RC exam, statistical significance could not be established due to the small sample size. It thus remains uncertain whether the act of writing PEs predicts passing the RC exam. However, the study objective was to identify candidates at high risk of failing the RC exam; the next step will be to determine which interventions can improve RC exam result. However, it must be acknowledged that PEs could not only identify candidates at risk of failing RC exam, but also improve their performance. This requires future study before any firm conclusions can be found.This study confirms that formative exams’ results can predict failure on the RC exam. The questions were written by authors who had recently written the RC exam, familiar with its format, and knowledgeable of the current Canadian guidelines, which are a focus of the actual RC exam. Because of confidentiality agreements with the RCPSC, actual RC exam questions can’t be shared, and thus can’t be used as part of the practice exams. However, we attempted to overcome this limitation by having all PE questions reviewed by at least 3 physicians who’d recently successfully completed the RC exam, to assure syntax and format was as similar as possible between PE and RC exam. Furthermore, this limitation does not impact the PEs statistically significant prediction of candidates at risk of failing the RC exam. The study objective was to identify candidates at risk of failing the RC exam, and the PEs are indeed a valid predictor of RC exam performance. There are limitations to this study. Firstly, this was a single centre study. However, Western University has a wide range of subspecialty programs available, and the trainees’ demographics resemble that at other Canadian centers. Secondly, new questions need to be created annually to reflect updated literature and guidelines; this requires ongoing commitment and dedication from staff. These “updated” exams could become more difficult to validate if candidates no longer fail the RC exam. However, if the act of taking the PE predicts passing RC, future research could focus on comparing RC pass rates at programs with and without the PEs. Thirdly, it's entirely possible that the use of questions from old RC exam would be more predictive, but these questions cannot be shared or used for PE due to the confidentiality agreement with the RCPSC. Therefore, creation of independent questions is still required. This is the first study of an assessment tool to predict performance on the Canadian internal medicine examination within the CBME framework. This strategy can easily be replicated and feedback is rapidly provided in a time sensitive manner. This could help trainees direct their preparation and identify knowledge gaps more easily.CONCLUSIONWe report an assessment tool to predict performance on the RC exam that can be a valid and useful form of feedback. This strategy can easily be replicated for other subspecialties or internal medicine programs. Future efforts need to focus on how the results can determine which interventions or learning strategies improve the results of candidates identified to be at risk for failing.DisclaimersThe authors declare they have no competing interest.The authors report no external funding source for this study.The authors declare no previous abstract or poster or research presentation or any online presentation of this study.REFERENCES 1. Caccia N, Nakajima A, Kent N. Competency-based medical education: the wave of the future. J Obstet Gynaecol Can 2015;37:349–53. 2. Carraccio C, Englander R, Gilhooly J, et al. Building a framework of entrustable professional activities, supported by competencies and milestones, to bridge the educational continuum. Acad Med 2016 ;92(3):324–30. doi: 10.1097/ACM.0000000000001141. 3. Carraccio C, Wolfsthal SD, Englander R, Ferentz K, Martin C. Shifting paradigms: from Flexner to competencies. Acad Med 2002;77:361–67. 4. Johnston C. Residents prepare for switch to competency-based medical education. CMAJ2013;185:1029. 5. Talbot M. Monkey see, monkey do: a critique of the competency model in graduate medical education. Med Educ 2004;38:587–92. 6. Long DM. Competency-based residency training: the next advance in graduate medical education. Acad Med 2000;75:1178–83. 7. Bell HS, Kozakowski SM, Winter RO. Competency-based education in family practice. Fam Med 1997;29:701–704.8. Mittman B. Frontrunners 2016: Internal Medicine Q&A Review: Syllabus Companion for Board Review/Practice Questions & Answers for the ABIM Exam. Aliso Viejo, CA: Frontrunners Publishing; 2016.9. Fischer C. Internal Medicine Question Book: Second Edition: Complete Preparation for the American Board of Internal Medicine Exam. New York, NY: Kaplan Publishing; 2009.
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