Extra Time Research Articles

The Graph Becomes the Dataset: Compiling Historical and Current RTG Data into One Place

Radioisotope thermoelectric generator (RTG) technology has a very long and incredibly successful history of providing heat and power to some of humankind’s most successful space exploration missions. Members of the community that support and maintain this technology often like to show the entire history of RTG performance on “The Graph.” Meant to impress, The Graph does its job in that regard. Unless you were connected to the right people, however, it was very difficult to get a copy of The Graph or its underlying data. This made it difficult for many to dive into the technical details or evaluate individual RTG performance from historical missions. To make matters worse, the performance for several missions in The Graph were incomplete. In 2020, with a little extra time on their hands thanks to COVID, the authors reached throughout the RTG community to locate and collate the missing RTG data. This information was then published as an open-source tabular Dataset. Users can now build their own version of The Graph or use the data for a more detailed analysis of RTG performance. Updates to the currently operating missions in The Dataset are expected to occur on a roughly annual basis. This Dataset represents the most comprehensive, authoritative, up-to-date repository of all RTG performance available today.

Perspectives on program duration and research: A survey of graduates of a 3-year medical physics residency program.

The goal of this manuscript is to evaluate strengths and weaknesses of a 3-year medical physics residency program with the first year dedicated to research and the remaining 2 years dedicated to clinical training. An anonymous survey was distributed to graduates of a 3-year medical physics residency program with a dedicated year of research. Questions focused on several categories: (1) in retrospect, factors graduates considered at the time of application, (2) aspects of respondents' career and life after graduating from residency, (3) respondents' opinions on the residency duration, and (4) research productivity during residency. Of 22 graduates who were contacted, 17 filled out the survey. In retrospect, the most impactful consideration at the time of application was quality of clinical training. Extra time for research was reported as the factor with the most positive career impact and financial considerations as the most negative impact of completing a 3-year residency. Preference for a 3-year residency at the time of application and in retrospect was expressed by 47% and 88% of respondents, respectively. 71% of respondents would recommend applying to a 3-year program to current residency candidates, and 29% respondents said their recommendation on entering a 3-year program would depend on the candidate's interests. 76% of respondents preferred dedicated time for research during residency. The optimal duration of medical physics residency depends on the goals and career objectives of the incoming residents. Two years may be an optimal duration for clinical training. For candidates interested in a career with a substantial research component, a 3-year program may be a good option, and graduates express favorable opinions after completing such a program. A 4-year residency duration is not viewed favorably by the graduates.

Využití 3D tisku při autotransplantaci moláru – kazuistika

The aim of this study is to show the experience with autotransplanted 3D model development and its use during surgery. The development of a 3D model has undergone three phases: building the virtual model, 3D printing and finally sterilisation. A 37-year-old female patient was recommended to our department for treatment of the 2nd quadrant. After planning the extraction of 26, 27 and consequently autotransplantation of tooth 28 was decided. According to CBCT data, two 3D models of the autotransplanted tooth were built and plasma sterilisation was done. After extraction of 26 and 27, a tooth cavity was prepared for the 3D model phantom and the autotransplantation was finished; extra alveolar time of tooth 28 was only 21 seconds. Healing period had no adverse problems and the patient was very satisfied with the result. Autotransplantation is one of the possible choices when treating malformation or tooth loss. The use of a 3D phantom during surgery leads to shortening of surgery time, thus lowering the risk of periodontal tissue damage by repeated testing of the right size of the tooth position and size.

6866 Real-world implications and limitations of GLP-1 prescriptions in adolescents

Abstract Disclosure: G. Castano: None. S. Sisley: None. Background: Glucagon-like-peptide-1 agonists (GLP1), approved for adolescents ≥ 10 years in 2019 for type 2 diabetes (T2D) and ≥ 12 years in 2020 for obesity, require adequate dose titration and have known side effects. There is little information on insurance approval, adherence to titration regimens, or the side effects of liraglutide in clinical practice. Methodology: We performed a retrospective review of all patients <18 years old who were prescribed GLP-1 at a large children’s hospital. We collected demographic information, prescription orders, insurance approval, and drug initiation dates. For individuals who completed at least 26±8 weeks of treatment, we also collected dose titration, side effects, and insulin doses. Results:599 patients were prescribed GLP-1 from 2019 to 2023, with a mean age of 14.99±2.1 years, 58% female, 58% public insurance, and 74% (n=442) with T2D. The cohort was comprised of 63% White, 30% Black, and 2.3% Asian individuals, with 52% of Hispanic ethnicity. 90% of prescriptions were for liraglutide, and 10% for other GLP1 analogs, including exenatide, dulaglutide, and semaglutide. Insurance denied 41% (n=244) of prescriptions, with more denials in those without T2D, 64% vs 32% in patients with T2D.Whereas private insurance denied more prescriptions than Medicaid in patients with T2D (54% vs 27%), the reverse was true for patients without T2D ( 55% private vs 69% Medicaid). Patients lost to follow-up in the first 3 months accounted for 22% (n=135) of the cohort, even though 48% (n=66) of those patients had insurance approval.Those who had insurance approval and took liraglutide for at least 26 weeks accounted for 34% (n=204) of the cohort. Of the patients with T2D, 50% (n=95) titrated to 1.8mg by their first follow-up appointment (1-3 months after prescription start), 33% (n=62) by 6 months, and 17% (n=32) never reached 1.8mg. In patients prescribed a higher dose of liraglutide (3.0 mg daily), 42% (n=8) titrated to 3mg over 5 weeks as prescribed, and 52% (n=10) never reached 3mg, with only one of them not reaching 1.8 mg.Most patients (82%, n=169) had no side effects documented in their charts. From those with side effects reported, GI problems (nausea, vomiting, diarrhea) were noted in 12% (n=25), and 2% (n=4) reported injection site reactions. Side effects that required medication discontinuation included hypoglycemia (n=1), mild pancreatitis (n=1), and severe pancreatitis (n=2). Conclusion: In clinical practice, despite FDA approval, insurance coverage of liraglutide is limited. Almost half of the patients require extra time to reach full doses of liraglutide, with one-third never reaching full treatment doses. Severe pancreatitis may be a previously unpublished side effect. More research is needed to understand how real-world adherence and side effects of liraglutide affect clinical outcomes. Presentation: 6/1/2024

Psychosocial and environmental motivational key factors behind the parenthood desire in infertile couples at the time of COVID-19.

To evaluate the main psychosocial motivational factors behind the increased adoption of IVF during the COVID-19 pandemic. This prospective, multicenter, observational case-control study assessed the factors motivating infertile couples to pursue their first IVF treatment during the pandemic across various IVF clinics in Spain, Portugal, Italy, the USA, and Panama. A pre-pandemic control group and a post-pandemic participant group were surveyed. The study was conducted between November 2021 and January 2023. The increase in IVF cycles was analyzed, and an ad hoc survey was developed to explore the motivational factors driving IVF engagement. Most clinics reported a significant increase in IVF demand (5.5-8.7%) for all indicators, including the number of started ovarian stimulations, oocyte pickups, and embryo transfers, following the declaration of the pandemic. The extra time spent and the reduced workload were the most important motivations prompting women to pursue their first fertility treatment during the pandemic (time to spend in the couple's relationship-OR, 1.53; 95% CI, 1.06-2.20; p < 0.05; decreased workload-OR, 2.63; 95% CI, 1.11-6.24; p < 0.05). This study highlights that infertility remains a significant stressor for individuals, and the desire to resolve it is not hindered by catastrophic events like COVID-19. Open communication between partners about reproductive intentions, combined with reduced work-related stress, is a key factor influencing the initiation of fertility treatment. It is crucial to encourage couples to take timely action in facing infertility.

The effect of low-intensity intradialytic cycling aerobic exercise on cognitive function in patients undergoing continuous hemodialysis

Background. End-stage renal disease (ESRD) patients often experience neurological complications. Mounting evidence suggests cognitive impairment associated with end-stage renal disease is likely related to vascular disruption in the brain, particularly in white matter integrity. Hemodialysis is an independent risk factor for mild cognitive decline (MCD) of ESRD patients and have serious implications for the quality of life. Intradialysis training is the most ideal choice for hemodialysis patients, because not requiring extra time and the patient is also under the supervision of a doctor when doing the exercises. Method. Eighteen patients with end-stage renal disease (ESRD) were randomized into two groups: a treatment group and a control group, with 9 patients in each group. The treatment group participated in low-intensity aerobic exercise on a cycle ergometer, consisting of two 30-minute sessions per week for 12 weeks. Both groups were instructed to continue their regular hemodialysis and medication regimen. MoCA-INA scores were measured before the intervention and again after 12 weeks for both groups. Comparisons of MoCA-INA scores were made within each group as well as between the two groups before and after the 12-week intervention. Results. In the treatment group, the MoCA-INA scores showed a significant improvement from baseline to after the intervention (p &lt; 0.001; effect size = 1.88). In contrast, the control group did not exhibit a significant change in MoCA-INA scores (p = 0.468). Additionally, there was a significant difference in the change in MoCA-INA scores between the treatment and control groups after 12 weeks of intervention (p = 0.001).

Operative Efficiency in Military Total Joint Arthroplasty Is Superior at an External Resource Sharing Agreement Facility as Compared to a Military Treatment Facility.

Surgeries within the Military Health System (MHS) are often performed by military physicians at External Resource Sharing Agreement (ERSA) hospitals to offload the operative demand at Military Treatment Facilities (MTFs). These agreements allow physicians flexibility in selecting where to treat military service members and other TRICARE beneficiaries. However, there is a paucity of military orthopedic literature comparing ERSA hospitals and MTFs. The objective of this study is to compare operative volume, efficiency, and orthopedic resident operative experience between an ERSA hospital and an MTF in military arthroplasty. A retrospective chart review was conducted for all surgeries performed between October 1, 2022 and July 31, 2023 by three military arthroplasty-trained surgeons at an MTF and two associated ERSA hospitals (denoted as ERSA-A and ERSA-B). Details recorded include spinal time-out time, spinal end time, in-room time, case start time, case stop time, and out-of-room time. These were used to calculate the total time in room (out-of-room time minus in-room time), case time (case stop time minus case start time), extra time in room (total time in room minus case time), and time between cases (in-room time minus out-of-room time of previous case). Lastly, we compared the average daily case volume and operative time between the facilities. Only primary joint replacements with properly documented time stamps were included in the efficiency analysis. Continuous variables were assessed for normality by the Shapiro-Wilk test. Non-normal data are presented as the median and interquartile range (IQR) and were analyzed using the Mann-Whitney U test (for two group comparisons) or the Kruskal-Wallis test (three or more groups) with Dwass-Steel-Chritchlow-Fligner pairwise comparisons. The associations between categorical variables were analyzed using the chi-squared test. Significance was set to P < .05. Statistical analyses were performed using SAS version 9.4 (Statistical Analysis Software, Cary, NC, USA). This study was classified as exempt human subjects research by the authors' institutional review board. Average daily case volume was significantly higher at both ERSA-A (median of 3, IQR 2-4, P < .001) and ERSA-B (median of 2, IQR 2-3, P = .0075) compared to the MTF (median of 2, IQR 1-2). This translated to residents operating for a median of 270 minutes (IQR 170-398, n = 25 OR days) each operative day at ERSA-A compared to 234 minutes (IQR 131-304, n = 91 OR days) when at the MTF, which was not a significant difference (P = .21). Median case time was 26.5 minutes lower (P < .001), extra time in room was 5 minutes lower (P < .001), and time between cases was 67 minutes lower (P < .001) in the ERSA group as compared to the MTF group. Utilizing ERSAs can improve patient throughput and operative efficiency, which in turn enhances orthopedic resident operative experience. These findings suggest that the MHS should seek ways to improve operative efficiency at MTFs. Expanding ERSA contracts to reach a broader portion of TRICARE beneficiaries, including patients over 65 years of age and those with supplemental insurance, who are currently ineligible, should also be explored.

Abstract B044: Assessing Native Americans’ readiness for lung cancer screening and smoking cessation

Abstract Introduction: Among all U.S. racial/ethnic populations, Native Americans (American Indians) experience the highest rates of commercial tobacco use and lung cancer incidence and mortality. The goal of the Native American Commercial Tobacco and lung cancer screening InterventiON Study (NACTIONS) is to address these disparities by measurably increasing lung cancer screening (LCS) in the context of smoking cessation. Building off a history of collaborations, the University of California, Davis (UCD) reached out to two Native-serving Federally Qualified Health Centers (FQHCs) in its catchment area to co-design means to improve lung health among their Native patients. Methods: In recognition of the extra time and effort involved, the UCD offered modest funding to these two FQHCs in inland northern California as well as gift cards for providers in sharing their practices in offering smoking cessation and LCS as well as interviews with their Native patients. Eligibility criteria for LCS were based on the 2021 US Preventive Services Task Force Recommendations that specified age: 50-80 years old and smoking history of 20 pack years for current smokers or those who quit within the past 15 years. We interviewed 14 providers and two categories of Native patients: both who had completed LCS (n=9) and those who are eligible but had not yet been screened (n=8) to understand facilitators, barriers, and solutions. A Native leader provided us with a conceptual framework to understand Native resiliency in addressing addiction to guide our approach. We also convened monthly meetings to discuss observations and co-design next steps. Findings: Both FQHCs reported approximately 400 Native patients eligible for LCS, but the readiness levels for interventions to promote smoking cessation and LCS were not the same. Each FQHC is under-resourced and each FQHC’s electronic medical system was not originally formulated for research. However, IT directors were willing to increase their scope to document patients’ readiness for intervention and their smoking histories through the LCS process. Common to both FQHCs is the essentiality of earned trust with their patients; adapting each FQHC’s electronic health system for precisely identifying eligible patients and longitudinally following them; assessing their social determinants of health; and the need to provide lung health education for the entire community. For instance, the high prevalence of diabetes, substance abuse, homelessness, etc. must be considered and the need to have tribal, friends, and family support for lung health can be reinforced through community-wide health education and patient navigation. Conclusions: This needs assessment documented factors that will enhance efforts for promoting LCS and smoking cessation at two Native-serving FQHCs. Promoting lung health through smoking cessation and increased completions of LCS can be better achieved through collaboration, addressing both social and physiological determinants of health, and earned trust. Citation Format: Julie Dang, Mayra Sandoval, David Cooke, Miriam Nuno, Carla Martin, Bobbi Jo Simmons, Teresa Martens, Elisa Tong, Moon S. Chen Jr. Assessing Native Americans’ readiness for lung cancer screening and smoking cessation [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B044.

PSXIII-5 Behavior and blood urea nitrogen in cattle grazing meadow bromegrass and supplemented with condensed and hydrolizable tannins

Abstract The nutritional value of grasslands declines as the season progresses, negatively impacting cattle nutrition. Protein supplementation may reverse this trend, although high rates of ruminal proteolysis reduce the efficiency of N utilization. Tannins decrease protein degradability in the rumen, although they are also plant defenses with potential to influence animal behavior. The objective of this study was to determine in protein-supplemented cows grazing meadow bromegrass (MB) the influence of tannins on blood urea nitrogen (BUN), and on behavioral levels of activity. Twenty-four Black Angus cow [body weight (BW) = 614 ± 20 kg]-calf (BW = 244 ± 4 Kg) pairs were allotted to six 9-acre paddocks (4 pairs/paddock); animals in the Control (Ctrl; n = 3) and Tannin treatments (TT; n = 3) grazed meadow bromegrass (MB) and had a supplement of dried distillers grains with solubles (DDGS; (1 kgּ cow-1ּ d-1), with the addition of a mix of condensed (2/3): hydrolizable tannins(1/3; SilvaTeam) at 0.4% of the diet for TT. Grazing occurred from July to September 2023 with four experimental periods of 15 d each, the first being the adaptation period (no tannins; Baseline). Data were analyzed as a mixed-effects model with repeated measures and paddock as the experimental unit. Cows were fitted with accelerometers on their left back leg to determine activity, and blood samples were collected from all animals at the end of each period to estimate BUN. Representative samples of grass and supplement were collected from each period and paddock and analyzed for CP and fiber content. Herbage availability (DM basis) in each paddock was assessed before and post-grazing during each period using a rising plate meter and calibration curves. neutral detergent fiber (NDF) (62.9 to 65.1 ± 0.5%) and and acid detergent fiber (ADF) (38.7 to 43.9 ± 0.3%) increased, whereas CP (6.8 to 3.9 ± 0.1%) declined from Period 1 to 4 (P &amp;lt; 0.05). Initial biomass was 5,272 ± 211 Kg/ha and it declined after grazing (Period 4) to 2,319 ± 94 Kg/ha (P &amp;lt; 0.05) with no differences between treatments (P &amp;gt; 0.05). No differences between treatments were observed on motion index, number of steps taken per day, and the proportional percentage of time cows spent standing (9,379 ± 740, 2,611 ± 300, and 54.9 ± 0.02%, respectively; P &amp;gt; 0.05), suggesting that cows in TT did not invest extra time in searching activities or resting relative to Ctrl. It was only detected a greater percentage of transitions from lying to standing in TT than in Ctrl (7 to 3.4 ± 0.003%; P &amp;lt; 0.001). Values for BUN did not differ between treatments (P &amp;gt; 0.05), although they declined from Baseline to Period 4 by 28 % (8.2 to 5.9 ± 0.2mg/dL) in TT and by 2.6 % (5.75 to 5.6 ± 0.01 mg/dL) in Ctrl (P &amp;lt; 0.05). These results suggest that the addition of low levels of tannins to a protein supplement in cows grazing a low-quality grass diet reduces ruminal proteolysis without adversely influencing biomass removal or animals’ levels of activity.

Enhancing Support for Slow Learners Evaluating Inclusive Education Models in Contemporary Classrooms

Present study assesses the effectiveness of inclusive education frameworks in supporting slow learners, a student needs extra time and resources to achieve academic success. The objective is to include these students in regular classes to promote fairness and social unity. Qualitative research study supported by six teachers working in primary, elementary, and secondary institutions in Karachi. The data collected provided thematic analysis identifying key challenges, strategies, and impacts in the implementation of inclusive education toward children with learning difficulties. Findings also show that though the models of inclusive education may uplift the slow learners both in academic performance and self-esteem, their effectiveness depends on adequate resources, flexible curriculum, and comprehensive training for teachers. Individual education plans and differentiated instruction are also identified as important. Future research has to be based on longitudinal studies and comparative studies across different cultural contexts of inclusive education models with specific attention to teacher preparation and the perspectives of slow learners.

Perceptions of extended-release buprenorphine among people who received medication for opioid use disorder in jail: a qualitative study

BackgroundIncarceration provides an opportunity for health interventions, including opioid use disorder (OUD) treatment and prevention of opioid-related overdoses post-release. All FDA-approved forms of medication for OUD (MOUD) treatment were mandated in several Massachusetts jails in 2019, with some jails offering extended-release buprenorphine (XR-Bup). Little is known about patient perspectives on and experiences with XR-Bup in carceral settings.MethodsWe conducted semi-structured interviews in 2022 with community-dwelling people who received MOUD during a recent incarceration in a Massachusetts jail. We asked participants about their experiences with and perspectives on XR-Bup while in jail. Qualitative data were double-coded deductively and reviewed inductively to identify emergent themes, which were structured using the Theoretical Framework of Acceptability (TFA).ResultsParticipants (n = 38) had a mean age of 41.5 years, were 86% male, 84% White, 24% Hispanic, and 95% continued to receive MOUD at the time of their interview, including 11% receiving XR-Bup. Participants who viewed XR-Bup favorably appreciated avoiding the taste of sublingual buprenorphine; avoiding procedural difficulties and indignities associated with daily dosing in carceral settings (e.g., mouth checks, stigmatizing treatment from correctional staff); avoiding daily reminders of their addiction; experiencing less withdrawal; having extra time for other activities, such as work; and reduction of diversion of MOUD within the jail setting. Participants who viewed XR-Bup less favorably preferred to maintain their daily dosing routine; liked daily time out of their housing unit; wanted to know what was “going into my body everyday”; and feared needles and adverse events. Participants also reported that jail clinicians used XR-Bup for patients who were previously caught diverting sublingual buprenorphine, suggesting limited patient participation in decision-making around XR-Bup initiation in some jails.ConclusionPeople who received MOUD in Massachusetts jails had both favorable and unfavorable views and experiences with XR-Bup. Understanding these preferences can inform protocols in jails that are considering implementation of XR-Bup treatment.

SP8.7 - The Impact of Covid-19 on ARCP Outcomes issued to Higher Specialty Trainees in General Surgery

Abstract Aims To quantify the impact of the Covid-19 pandemic on the Annual Review of Competency Progression (ARCP) outcomes of higher specialty trainees in General Surgery in the UK. Methods All ARCP outcomes awarded to higher specialty trainees in General Surgery between 2017 and 2022 were collated from Intercollegiate Surgical Curriculum Programme (ISCP). Associations between year, trainee sex, age, stage of training, and outcome were explored using multivariate logistic regression models. Results A total of 7,414 outcomes issued to 1,874 trainees were analysed. The Adjusted Odds Ratio (AOR) of receiving a non-standard outcome in 2020 (compared to 2017) was 3.07 (95% CI:2.47–3.81, P&amp;lt;0.001) and this remained elevated through 2022 (2.11, 95% CI:1.69–2.64, P&amp;lt;0.001). Female (AOR 1.27 (95% CI: 1.13–1.43, P&amp;lt;0.001) and older trainees (1.51 (95% CI:1.34–1.70, P&amp;lt;0.001) were more likely to receive non-standard outcomes. Being at a later stage of training during the pandemic did not increase the chances of receiving non-standard outcomes (AOR 1.09, 95% CI:0.97-1.22, P=0.134), but more outcomes advising extra training time were issued to this group (15.5% versus 4.3% in 2021). There was significant regional difference in the use of Covid-19 outcomes. The awarding of non-standard outcomes rose most years, even outside of the pandemic. Conclusions The Covid-19 pandemic had significant impact on the training trajectory of UK General Surgical trainees. Female and older trainees were more likely to receive non-standard ARCP outcomes before and during Covid-19. Urgent efforts are required to restore surgical training, and addressing differential attainment is essential for success.

Exploration of Workaholic Characteristics of Married Women in Healthcare sector during Pandemic situations

Women in professional and family life are facing lot of challenges where they are struggling to manage their work pressure and family responsibilities. In healthcare sectors, the employees especially the nurses have to carry out shift work and have to perform morning, evening and night shifts. It is analysed and proved by many analysts that mostly the women from middleclass family life are subject to such work-life challenges in particular the women nurses especially during pandemic situations. This study focuses on Workaholism which is an extreme work force that leads to the disregard of others’ welfare and harmful effects faced by the women nurses especially who are married. In this aspect, the research was conducted to examine the workaholic characteristics of married women especially the nursing professionals during the pandemic period. The study was conducted by collecting data from women nurses from South part of India and the sample size derived for the study is 200. The findings reveal that Continuous thoughts of Work Involvement, Accepts Extra Work Time, Task Oriented, Compensation based on Work Performance and No Botheration about Work life Balance are the major workaholic characteristics of women nurses especially who are married.

Empathy ability and influencing factors among pediatric residents in China: a mixed-methods study

BackgroundEmpathy is one of the fundamental factors enhancing the therapeutic effects of physician–patient relationships, but there has been no relevant research in China on the pediatric resident physicians’ capacity for empathy or the influencing factors.MethodsA mixed-methods study was undertaken. The student version of the Jefferson Scale of Empathy was used to assess 181 postgraduate residents at Shanghai Children’s Medical Center and Shanghai Children’s Hospital. Differences in empathy ability among pediatric resident physicians of different genders and specialties were analyzed using independent sample t-tests and Mann–Whitney U tests. A one-way analysis of variance was used to analyze the differences in empathy ability at different educational levels and years of medical residency training. Seven third-year postgraduate pediatric residents from Shanghai Children’s Medical Center participated in semi-structured interviews exploring the influencing factors. We analyzed the interview transcripts using thematic analysis.ResultsThe scale was completed by 154 pediatric residents. No statistically significant differences in empathy were found between educational level, postgraduate year, gender, or specialty. The factors influencing empathy in doctor–patient communication included the person who accompanied the child to see the doctor, how the children cooperated with doctors for medical treatment, the volume of pediatric outpatient and emergency visits, and the physician’s ability to withstand pressure. All interviewed resident physicians regarded learning empathy as important but rarely spent extra time learning it.ConclusionsThe evaluation results of resident physicians on changes in empathy after improving clinical abilities vary according to their understanding of empathy, and the work environment has an important impact on pediatricians’ empathy ability. Their empathy score is relatively low, and this requires exploration and intervention.

Heat pipe type double-containment vessel as passive safety system for small modular reactors

This paper proposes a new concept of a passive safety system for small modular reactors as a heat pipe type double-containment vessel. The proposed system configures an additional vessel outside the existing one and functions as a heat pipe that utilizes phase change heat transfer to reduce the requirement of a large pool design. The double-containment vessel features a design consisting solely of the evaporation and condensation sections for heat pipe function with compactness. The ultimate heat sink only serves as a condenser part for the double-containment vessel, therefore significantly reducing the volume of stored fluid. The study numerically evaluates several postulated accidental cases to compare the performance of the double-containment vessel using the thermal hydraulic system code, MARS-KS. Even for serious conditions such as multiple failure accidents without safety systems operation, the double-containment can secure extra golden time to core damage by more than 2,090 sec compared to the original design. This study highlights the feasibility and potential of the heat pipe-based double-containment vessel as a passive safety system, enhancing the safety and reliability of small modular reactors. This kind of design can provide the advantages of safety and economics in the construction of small modular reactors.

Improving Fast Adversarial Training With Prior-Guided Knowledge.

Fast adversarial training (FAT) is an efficient method to improve robustness in white-box attack scenarios. However, the original FAT suffers from catastrophic overfitting, which dramatically and suddenly reduces robustness after a few training epochs. Although various FAT variants have been proposed to prevent overfitting, they require high training time. In this paper, we investigate the relationship between adversarial example quality and catastrophic overfitting by comparing the training processes of standard adversarial training and FAT. We find that catastrophic overfitting occurs when the attack success rate of adversarial examples becomes worse. Based on this observation, we propose a positive prior-guided adversarial initialization to prevent overfitting by improving adversarial example quality without extra training time. This initialization is generated by using high-quality adversarial perturbations from the historical training process. We provide theoretical analysis for the proposed initialization and propose a prior-guided regularization method that boosts the smoothness of the loss function. Additionally, we design a prior-guided ensemble FAT method that averages the different model weights of historical models using different decay rates. Our proposed method, called FGSM-PGK, assembles the prior-guided knowledge, i.e., the prior-guided initialization and model weights, acquired during the historical training process. The proposed method can effectively improve the model's adversarial robustness in white-box attack scenarios. Evaluations of four datasets demonstrate the superiority of the proposed method.

Novel energy savings method considering extra sensor battery discharge time for fish farming applications

Energy savings in Wireless Sensor Networks for fish farms is necessary and beneficial. We present a novel energy savings method that minimizes the interpolation errors of sensors' measurements. Sensors follow a working cycle in which they are active when measuring data, and inactive or suspended when data is interpolated from the above measurements and consumed energy is reduced. To our knowledge, we are the first to implement interpolation for energy savings. We improved that model to describe the non-linear property of the consumed energy in the batteries, adding a new variable that explains their real behavior. Several experiments with a prototype of a Wireless Sensor Network with pH, water temperature, and ambient temperature sensors are implemented to validate our method. We made a series of measurements to determine the actual energy savings at each sensor and compared these savings with those predicted by each theory model. The results show that the model is more accurate, presenting less than 5 % prediction errors which does not affect fish growth. Furthermore, our paper introduces an energy-saving method for extending WSN lifetime by modeling the non-linear power consumption of sensors' batteries. We propose a new mathematical optimization formulation using an efficient interpolation mechanism that operates in real-time. A real-scale WSN prototype installed over water validates and refines our method. Finally, we showed that the number of interpolated values is of a broader range for aquatic sensors than for outdoor sensors such as ambient temperature. That is, energy savings for fish farming is acceptable.

First Results of Pediatric Robotic Inguinal Hernia Repair with the Senhance® Surgical System: A Matched Cohort Study.

Inguinal hernia repair (IHR) is one of the most common procedures in pediatric surgery. In children, the application of robotic surgery is limited, meaning safety and efficacy is still to be assessed. This report is the first one worldwide that describes inguinal hernia repair in children using the Senhance® Surgical System (SSS®). The aim of this matched cohort study is to assess safety and feasibility of robot-assisted IHR (RIHR) in children, compared to conventional laparoscopic IHR (LIHR). This pilot study included 26 consecutive patients between 3 months and 8 years old who underwent RIHR (31 IH's) with the SSS® between 2020 and 2024. These cases were matched based on gender, age, and unilateral or bilateral IH, with 26 patients (32 IH's) who underwent conventional LIHR. There was a significant difference in total anesthesia time, which is most likely due to the extra time needed to dock the robot in the RIHR cases. No significant difference was seen in surgical time. One recurrence (3.2%) was diagnosed in both groups. One patient in the LIHR group was readmitted on the day of discharge due to a hemorrhage. No intervention was necessary, and the patient was discharged 1 day later. In this pilot study, the use of the robotic system was safe and feasible. More experience, further improvement of the system for use in very small children, and investigation in a larger sample size with long-term follow-up is necessary to evaluate efficacy.

A human centered design approach to define and measure documentation quality using an EHR virtual simulation.

Electronic health record (EHR) documentation serves multiple functions, including recording patient health status, enabling interprofessional communication, supporting billing, and providing data to support the quality infrastructure of a Learning Healthcare System. There is no definition and standardized method to assess documentation quality in EHRs. Using a human-centered design (HCD) approach, we define and describe a method to measure documentation quality. Documentation quality was defined as timely, accurate, user-centered, and efficient. Measurement of quality used a virtual simulated standardized patient visit via an EHR vendor platform. By observing and recording documentation efforts, nurse practitioners (NPs) (N = 12) documented the delivery of an Age-Friendly Health System (AFHS) 4Ms (what Matters, Medication, Mentation, and Mobility) clinic visit using a standardized case. Results for timely documentation indicated considerable variability in completion times of documenting the 4Ms. Accuracy varied, as there were many types of episodes of erroneous documentation and extra time in seconds in documenting the 4Ms. The type and frequency of erroneous documentation efforts were related to navigation burden when navigating to different documentation tabs. The evaluated system demonstrated poor usability, with most participants scoring between 60 and 70 on the System Usability Scale (SUS). Efficiency, measured as click burden (the number of clicks used to navigate through a software system), revealed significant variability in the number of clicks required, with the NPs averaging approximately 13 clicks above the minimum requirement. The HCD methodology used in this study to assess the documentation quality proved feasible and provided valuable information on the quality of documentation. By assessing the quality of documentation, the gathered data can be leveraged to enhance documentation, optimize user experience, and elevate the quality of data within a Learning Healthcare System.

Automation and Augmentation: Artificial Intelligence, Robots, and Work

This article reviews the literature that examines the potential, limitations, and consequences of robots and artificial intelligence (AI) in automation and augmentation across various disciplines. It presents key observations and suggestions from the literature review. Firstly, displacement effects from task automation continue to persist. However, one should not assume an unequivocally increasing efficacy of technology in automation or augmentation, especially given the declining productivity growth in high-income countries and some large emerging economies in recent decades. Jobs less likely to be negatively impacted are those that require diverse tasks, physical dexterity, tacit knowledge, or flexibility, or are protected by professional or trade associations. Despite countervailing effects, without policy intervention, automation and augmentation could widen inequality between social groups, labor and capital, and firms. Secondly, AI's promise in task automation and labor augmentation is mixed. AI tools can cause harm, and dissatisfaction and disengagement often arise from their opaqueness, errors, disregard for critical contexts, lack of tacit knowledge, and lack of domain expertise, as well as their demand for extra labor time and resources. The inadequate autonomy to override AI-based assessments further frustrates users who have to use these AI tools at work. Finally, the article calls for sociological research to specify conditions and mechanisms that ameliorate adverse consequences and enhance labor augmentation by embedding the study of automation and augmentation in concrete social and political contexts at multiple levels.