Medical Settings Research Articles

Medical communication, internalized “good mother” norms, and feminist self-identification as predictors of maternal burnout

IntroductionA rarely studied source of psychological discomfort for mothers is the communication received from medical professionals in the context of pregnancy, childbirth, the postpartum period, and pediatric care. To address this gap, we examined mothers’ recollections of medical communications that influenced their perceived stress levels in the context of good-mother normativity. We also explored how recollections of feedback on mothering in medical settings were associated with internalization of good-mother expectations, maternal burnout, length of motherhood, and feminist self-identification.MethodsWe collected the data through an online survey administered by a company that pre-establishes business relationships with potential survey takers. The survey-takers were 254 self-identified mothers, who answered open-ended questions about their recollections of medical communications related to good-motherhood norms. The participants also completed measures of maternal burnout, internalized good mother expectations, and feminist self-identification, and answered demographic questions such as age, education, number of children, and how long they had been mothers.ResultsParticipants who recalled discomfort-inducing medical communications that directly or indirectly referenced motherhood norms reported higher levels of internalized good-mother expectations and maternal burnout. A process model showed that the frequency of recalled medical communications, length of motherhood, and feminist self-identification moderated the relationship between the degree of internalization of good-mother expectations and maternal burnout. A significant association emerged between feminist self-identification and the recalled frequency of interactions with medical professionals that increased mothers’ perceived stress stemming from good-mother normativity.DiscussionThe findings of this study contribute to self-discrepancy theory as it relates to the social construction of mothers’ identities by focusing on whether and how often medical professionals reinforce or challenge good-mother social expectations. Another theoretical contribution of this study is that values and beliefs, such as feminist self-identification, can affect the recall of communications about social norms and are significantly associated with levels of internalized expectations and resulting burnout. In terms of practical implications, our findings suggest that medical professionals should be mindful of how they assess patients through the lens of the good-mother norms and also consider addressing the discomfort stemming from such normativity by asking mothers about their perceptions of social expectations and addressing unrealistic beliefs that aggravate mothers’ sense of self-discrepancy.

Teaching Medical Students Rapid Ultrasound for shock and hypotension (RUSH): learning outcomes and clinical performance in a proof-of-concept study

BackgroundPoint-of-care ultrasound (POCUS) is a critical diagnostic tool in various medical settings, yet its instruction in medical education is inconsistent. The Rapid Ultrasound for Shock and Hypotension (RUSH) protocol is a comprehensive diagnostic tool, but its complexity poses challenges for teaching and learning. This study evaluates the effectiveness of a single-day training in RUSH for medical students by assessing their performance in clinical scenarios.MethodsIn this prospective single-center observational proof-of-concept study, 16 medical students from Saarland University Medical Center underwent a single-day training in RUSH, followed by evaluations in clinical settings and on a high-fidelity simulator. Performance was assessed using a standardized scoring tool and time to complete the RUSH exam. Knowledge gain was measured with pre- and post-training written exams, and diagnostic performance was evaluated with an objective structured clinical examination (OSCE).ResultsStudents demonstrated high performance in RUSH exam views across patients (median performance: 85–87%) and improved scanning times, although not statistically significant. They performed better on simulators than on live patients. Written exam scores significantly improved post-training, suggesting a gain in theoretical knowledge. However, more than a third of students could not complete the RUSH exam within five minutes on live patients.ConclusionsSingle-day RUSH training improved medical students’ theoretical knowledge and simulator performance but translating these skills to clinical settings proved challenging. The findings suggest that while short-term training can be beneficial, it may not suffice for clinical proficiency. This study underscores the need for structured and possibly longitudinal training programs to ensure skill retention and clinical applicability.

Dense Contrastive-based Federated Learning for Dense Prediction Tasks on Medical Images.

Deep learning (DL) models have achieved remarkable success in various domains. But training an accurate DL model requires large amounts of data, which can be challenging to obtain in medical settings due to privacy concerns. Recently, federated learning (FL) has emerged as a promising solution that shares local models instead of raw data. However, FL in medical settings faces challenges of client drift due to the data heterogeneity across dispersed institutions. Although there exist studies to address this challenge, they mainly focus on the classification tasks that learn global representation of an entire image. Few have been studied on the dense prediction tasks, such as object detection. In this study, we propose dense contrastive-based federated learning (DCFL) tailored for dense prediction tasks in FL settings. DCFL introduces dense contrastive learning to FL, which aligns the local optimization objectives towards the global objective by maximizing the agreement of representations between the global and local models. Moreover, to improve the performance of dense target prediction at each level, DCFL applies multi-scale contrastive representation by utilizing multi-scale representations with dense features in contrastive learning. We evaluated DCFL on a set of realistic datasets for pulmonary nodule detection. DCFL demonstrates an overall performance improvement compared with the other federated learning methods in heterogeneous settings-improving the mean average precision by 4.13% and testing recall by 6.07% in highly heterogeneous settings.

Pratiquer la clinique en « milieu hostile » : quels possibles ?

ContextBy imposing techniques, reporting, efficiency, and profitability on hospital practices, New Public Management has considerably altered the role of psychologists in medical departments, as well as their relationship with teams and administrative staff. ObjectiveThe aim of this reflection is to highlight the positions that appear most appropriate for continuing to promote the activity of hospital clinical psychologists in this disrupted context. MethodThe author traces the evolution of the place of psychologists in medical settings, and draws on his own experience in the face of the disruptions encountered to examine what makes it possible to hold one's place as a clinical psychologist in a hospital institution. ResultsPositioning oneself as “carried by” an intention or a meaning, rather than “against” someone or a hierarchy, is necessary for one's clinical practice. By enabling us to continue questioning our subjectivities, the clinical approach has become an “authority” in relationships, transcending hierarchies. While accompanying the interlocutor, it naturally opens the way to joint elaboration. In addition to seminars, supervisions, and affiliations with psychoanalytic schools or groups, psychologists must also join psychologists’ collectives, such as colleges of psychologists or inter-colleges, in order to think about, discuss, and elaborate clinical possibilities. ConclusionThe work of clinical psychologists in hospitals is an act of resistance in itself. However, it is a natural outcome of our activity and should not become a goal in itself. It's about continuing to reflect on the complex situations we deal with, so that the obvious can emerge. Continually focusing on analyzing requests with tact allows us to modernize the authority inherent in the clinical approach itself, and to establish the autonomy of psychologists without them behaving like loose cannons, instead truly asserting their expertise. If valuable qualitative links are thus established with the interlocutors, the approach requires fully accepting the constraint of these links and of the debate which takes place throughout this analysis, whose finality is uncertain.

Black Latina Passages through Colonial Ecologies of Illness and the Art of Composting Aesthetics

Drawing from Black Latinx and feminist thought to place Latinx Studies and medical/health humanities in conversation, this project asks, what are the medical and colonial histories, personal and collective, that inform patients’ perceptions of illness and Western biomedicine? What happens in cases when Latinx patients have internalized historical forms of medical violence, and what are the means by which Latinx patients construct their healing through narrative? These questions are grounded in material conditions with special concerns for the well-being of Latinx patients, but they are explored via a historically and culturally informed literary analysis of Jasminne Méndez’s Night-Blooming Jasmin(n)e (Night-Blooming), a personal illness narrative composed of poems and lyrical essays that portrays, among other health conditions, Méndez’s life with Scleroderma, Lupus, and Raynaud’s disease. Offering a close reading of Night-Blooming’s biomedical critiques alongside the ecological language, metaphors, and formal structure she employs to describe her illness, the author argues that narratives such as Night-Blooming require us to travel into the colonial ecologies of illness, environmental characteristics, practices, and rhetoric in medical settings that evoke colonial encounters from within and beyond the strict boundaries of healthcare facilities. This essay also follows in the passages of Méndez’s figurative travels to the island of Hispaniola as she works to recover her language, health, and Black roots. Acknowledging the ways Méndez’s chronic illness and biomedicine distort her (textual) body, psychiatric health, and language becomes necessary to appreciate Méndez’s composting aesthetics of illness, healing work that involves a struggle to recover that which is painful and deteriorating for life-affirming and life-sustaining purposes. I suggest that by enacting an aestheticization of illness alongside experiences of pain, Méndez uses Night-Blooming as a conduit to theorize about the potential for transforming human suffering from chronic illness into a means toward cultivating life.

Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study.

Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient's recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers. This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs. We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual's patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual's changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes. In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use. KIOS tracks key clinical variables and generates advice specifically relevant to the patient's current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse-funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted.

Screening and Intervention to Prevent Violence Against Health Professionals from Hospitalized Patients: A Pilot Study

Health care providers, particularly nursing staff, are at risk of physical or emotional abuse from patients. This abuse has been associated with increased use of physical and pharmacological restraints on patients, poor patient outcomes, high staff turnover, and reduced job satisfaction. In this study, a multidisciplinary team at Tufts Medical Center implemented the Brøset Violence Checklist (BVC), a screening tool administered by nurses to identify patients displaying agitated behavior. Patients who scored high on the BVC received a psychiatry consultation, followed by assessments and recommendations. This tool was implemented in an inpatient medical setting in conjunction with a one-hour de-escalation training led by nursing and Public Safety. The intervention design was executed through a series of three distinct Plan-Do-Study-Act cycles. This study measured the number of BVCs completed and their scores, the number of psychiatric consults placed, the number of calls to Public Safety, the number of staff assaults, nursing restraint use, and staff satisfaction. During the study period, restraint use decreased 17.6% from baseline mean and calls to Public Safety decreased 60.0% from baseline mean. In the staff survey, nursing staff reported feeling safer at work and feeling better equipped to care for agitated patients. The BVC is an effective, low-cost tool to proactively identify patients displaying agitated or aggressive behavior. Simple algorithms for next steps in interventions and training help to mitigate risk and increase feelings of safety among staff. Regular psychiatric rounding and the identification of champions were key components in a successful implementation.

Estimating the cost of Rh testing and prophylaxis in early pregnancy: A time-driven activity-based costing study

ObjectiveTo estimate the cost of Rhesus (Rh) testing and prophylaxis for first-trimester vaginal bleeding in the ambulatory setting. Study designWe used time-driven, activity-based costing to analyze tasks associated with Rh testing and prophylaxis of first-trimester vaginal bleeding at one hospital-based outpatient and two independent reproductive health clinics. At each site, we observed 10 patients undergoing Rh-typing and two patients undergoing Rh prophylaxis. We computed the costs of blood Rh-typing by both fingerstick and phlebotomy, cost of locating previous blood type in the electronic health record (available for 69.8% of hospital-based patients), and costs associated with Rh immune globulin prophylaxis. All costs are reported in 2021 US dollars. ResultsThe hospital-based clinic reviewed the electronic health record to confirm Rh-status (cost, $26.18 per patient) and performed a phlebotomy, at $47.11 per patient, if none was recorded. The independent clinics typed blood by fingerstick, at a per-patient cost of $4.07. Rh-immune globulin administration costs, including the medication, were similar across facilities, at a mean of $145.66 per patient. Projected yearly costs for testing and prophylaxis were $55,831 for the hospital-based clinic, which was the lowest-volume site, $47,941 for Clinic A, which saw 150 patients/month, and $185,654 for Clinic B, which saw 600 patients/month. ConclusionsRh testing and prophylaxis for first-trimester vaginal bleeding generates considerable costs for outpatient facilities, even for Rh-positive patients with a prior blood type on record. ImplicationsRh testing and prophylaxis for first-trimester bleeding generate considerable costs even for Rh-positive patients and those with a previously known blood type. These findings highlight the need to reconsider this practice, which is no longer supported by evidence and already safely waived in multiple medical settings in the United States and around the world.

Differences in aging rates based on different methods of calculation in patients with arterial hypertension and subclinical hypothyroidism

Objective — to evaluate two distinct methods for determining biological age (BA) and aging rates among patients with arterial hypertension (AH) in combination with subclinical hypothyroidism (SH) that can be applicable to practical medical settings.
 Materials and methods. The study involved 150 patients (women 54.7%, n=82) with an average age of 47.1 [39.7;54.0] years, who were divided into three groups reciprocal by age and sex: the main group included 70 patients with AH in combined with SH, the comparison group consisted of 50 subjects with isolated AH, and control group of 30 healthy volunteers. All subjects were assessed for objective data, anthropometric status, standard clinical‑biochemical indicators, insulin, HOMA IR, C‑reactive protein (CRP), tumor necrosis factor‑alpha (TNF‑α), thyroid‑stimulating hormone (TSH), free thyroxine (T4), and sirtuin 1 (SIRT1). Additionally, the pro‑oxidant‑antioxidant balance was evaluated by assessing total hydroperoxides (THP) levels and total antioxidant activity (TAA). The assessment of BA and aging rates (ΔBA) were chosen as the main markers of premature aging and were performed with two different methods: by M. Levin et al. (ΔBA1), by authors’ own method (ΔBA2). Depending on ΔBA, patients from all three groups were divided into subgroups with normal/slowed aging rates (ΔBA ≤0) and accelerated aging rates (ΔBA >0).
 Results. According to ΔBA1 (p=0.004), 4 subjects with accelerated aging rates reveled in the controls, while in the main group the rate was 2.2 times higher than in the comparison group (40.0% versus 18%). According to ΔBA2 (p=0.0001), more people had an increased aging rates both in the main group and in the comparison group (57.1% versus 38.0%). Patients with AH and accelerated aging rates according to ΔBA1 had significant differences in the levels of SIRT1 (p=0.012), aspartate aminotransferase (AST) (p=0.012), alanine aminotransferase (ALT) (p=0.005), uric acid (p=0.011), and diastolic blood pressure (DBP) (p=0.001), and according to ΔBA2, higher levels of insulin (p=0.019), HOMA IR (p=0.013), triglycerides (TG) (p=0.011), very low‑density lipoprotein cholesterol (VLDL‑C) (p=0.020), DBP (p=0.032), and lower levels of total protein (p=0.048), compared to patients with AH and normal/slower aging rates. In the group of patients with AH combined with SH, differences in the levels of THP (p=0.023), uric acid (p=0.044), and body mass index (BMI) (p=0.046) were found among patients with different aging rates according to ΔBA1, and according to the results of the ΔBA2 assessment — in the levels of glucose (p=0.045) and uric acid (p=0.026). Among the studied patients in the AH group and in the group with a combined course of AH and SH, there were 52 patients whose aging rates (accelerated and normal/slowed) did not coincide in the assessment according to ΔBA1 and ΔBA2 : 11 patients had accelerated aging rates only according to ΔBA1, and 23 patients — only according to ΔBA2. Among the aforementioned 52 patients, 50% had elevated levels of ALT, 32.7% — AST, 3.8 — alkaline phosphatase (ALP), 90.2% — HOMA IR, 80.8% — total cholesterol (TC), 28.8% — triglycerides (TG), 26.9% had decreased levels of high‑density lipoprotein cholesterol (HDL‑C), 82.7% had elevated levels of LDL‑C, 15.4% — creatinine, 46.2% had decreased eGFR, 15.4% had elevated levels of CRP, 3.8% — TNF‑α, and 50.0% had uncontrolled levels of systolic and diastolic BP.
 Conclusions. Assessment of BA should be mandatory for patients with AH and SH to enable early detection and prevention of premature aging. As an indicator of accelerated aging rates, the combined use of ΔBA assessment based on clinical and biochemical indicators according to the method of M. Levin et al. (2018), as well on our own developed method based on the assessment of anthropometric indicators, TSH levels and the content of THP can be effective. Primary determination of BA can be conducted during regular (e.g., annual) preventive screening of patients. In case of detection of cardiometabolic disorders, repeat determination of BA can be performed after some time following their correction.

Design of a fast cassette autoclaves for medical devices

Ensuring patient safety in healthcare necessitates the sterilization of medical devices. However, traditional autoclaves are impractical for certain medical settings due to their size, bulkiness, and time-consuming nature. To address this, a compact and portable alternative called a cassette autoclave was developed. This paper presents the design and manufacturing process of a high-speed cassette autoclave for medical devices. The autoclave features small dimensions, lightweight construction, and user-friendly operation. It achieves remarkable speed, sterilizing devices in approximately 3.5 minutes. Made of durable stainless steel, it includes a digital control panel for seamless management. Extensive testing and validation ensure compliance with sterilization standards. The results highlight the autoclave's effectiveness and safety, making a significant contribution to medical device sterilization.

Challenges for international medical graduates in the US and the UK graduate medical education and health care system environment: A comprehensive review

A comprehensive review of past research and statistical data is necessary to understand the significant obstacles encountered by International Medical Graduates (IMGs) in the healthcare systems of the USA and UK. A careful review of the literature shows that financial, cultural, and linguistic barriers are worsened by the intricate USA licensing processes overseen by the ECFMG. The BMJ and the AAMC's research statistics demonstrate the prevalence of these difficulties and their impact on the career trajectories and well-being of IMGs. The study assesses the impact of professional networks, mentoring programs, and support systems in addressing challenges faced by IMGs in the healthcare sectors of the US and UK, emphasizing the significance of evidence-based interventions in developing inclusion and equality. International Medical Graduates (IMGs) play an important role in graduate medical education and broad medical settings, but their integration present challenges that need thoughtful evaluation of many concerns they face.

“Neutrality Is Affirming”: How Do Sexual and Gender Minority Adults Find and Define Affirming Healthcare?

Sexual and gender minority (SGM) individuals have unique healthcare needs yet frequently encounter negative healthcare experiences. These negative encounters with the healthcare system may lead to SGM individuals delaying or avoiding healthcare, which may exacerbate health disparities. We sought to qualitatively examine the healthcare experiences of SGM adults to better understand how SGM adults define SGM-affirming healthcare experiences. We also aimed to add to the literature by asking SGM participants about their future aging and healthcare concerns such as family involvement in medical decisions and end-of-life care. Nineteen semistructured individual interviews were conducted with SGM adults to gather information about the process of finding an SGM-affirming provider, coming out in a medical setting, the components of affirming care, the results of affirming care, the components of nonaffirming care, the consequences of nonaffirming experiences, and aging concerns regarding healthcare. A thematic analysis approach was used to analyze interview data. Results showed unique insights into the techniques used to find SGM-affirming providers and what SGM adults hope for in their healthcare encounters. This qualitative study builds on a body of literature that has documented significant disparities in healthcare access and quality for SGM individuals. The results of this study highlight important aspects of SGM-affirming care, outline understudied healthcare concerns for SGM people, and may guide healthcare providers in improving the quality-of-care experiences for their SGM patients.

"Integrated behavioral health plus": The best of the worlds of collaborative care management, primary care behavioral health, and primary care.

Discussions comparing the components and virtues of models of integrated behavioral health (IBH), that is, collaborative care management and primary care behavioral health, have been ongoing. In this conceptual article, we recommend shifting the focus to a broader set of components we have found essential to serve the needs of our patients, and hopefully the broader aims of dissemination and implementation of IBH. We detail our 20-year experience including the personnel, program components, challenges, successes, and plans for the future that will meet our patients' behavioral health needs and serve primary care. We compare our "IBH Plus" approach using the central tenets of primary care known as the "six Cs" (6Cs) to two dominant models, illustrating differences and similarities among them. The "6Cs" are first contact/accessibility, continuity, comprehensiveness, coordination, context-based, and accountability. We detail how each of these "6Cs" guides the structure and functioning of IBH Plus in the team-based patient-centered medical home setting. We believe IBH Plus more clearly relates to and supports the rest of the primary care transformation movement while integrating components of the most popular models of IBH and may support greater implementation of IBH. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Frequency of Neck Pain and Associated Disability in Medical Students

Background: Musculoskeletal disorders, particularly neck pain, have been increasingly documented among medical students due to their rigorous academic and clinical training demands. The impact of neck pain can lead to significant disability, affecting academic performance and quality of life. Prior studies have demonstrated varying prevalence across different geographies, indicating a need for further localized research. Objective: This study aimed to assess the prevalence of neck pain and its associated disability using the neck disability index among students of Akhtar Saeed Medical College and to compare these findings with global data. Methods: A cross-sectional descriptive study design was employed, involving 150 students from various medical programs. Data collection was conducted via a structured questionnaire including the Neck Pain Disability Index and the Visual Analog Scale for pain intensity. Ethical approval was obtained in line with the Helsinki Declaration. The sample size was determined statistically, and the collected data were analyzed using SPSS version 24.0. Statistical tests including independent t-tests and Chi-square tests were utilized to discern the significance of associations, with a p-value of less than 0.05 considered statistically significant. Results: Participants had an average age of 22.74±2.04 years, with a gender distribution of 58.7% female and 41.3% male. The mean score for neck pain disability was higher in females (21.33±6.45) compared to males (20.76±5.11), albeit non-significantly (p=0.562). The prevalence of neck pain in our sample (58.7%) was higher than in similar cohorts from Brazil (8.23%), Thailand (22.3%), and China (33.8%), yet comparable to Pakistan (44.8%), Australia (52.8%), and Central Saudi Arabia (54%). Approximately 22.7% of students reported neck pain that interfered with their normal activities. Conclusion: Neck pain was found to be prevalent among the medical student population, with a higher incidence in females. The study underscores the association between neck pain and disability, suggesting the need for preventive measures and interventions within the medical academic setting.

Development of a rapid tool for screening financial toxicity based on the comprehensive score for financial toxicity

ObjectiveThis study aimed to use item response theory (IRT) to develop and validate a short version of the Chinese COmprehensive Score for financial Toxicity (COST-S-C) in patients with cancer. MethodsA total of 500 patients with cancer participated in the survey. Confirmatory factor analysis (CFA) was used to assess the factor structure of the COST-S-C. A two-parameter IRT model was used to examine the item fit of the COST-S-C. Item discrimination, item characteristic curves (ICCs), item information curves (IICs), and item fit were estimated. Differential item functioning (DIF) was assessed for participants’ gender and age. Reliability, convergent and discriminant validity was examined as well as estimating the optimal cut-off points of the COST-S-C. ResultsThe CFA results supported the bi-factor structure of the COST-S-C. The IRT analysis findings revealed that several items showed problems with the ICCs, providing little information in terms of IICs as well as poor discrimination. Item 5 showed a negligible DIF problem with age. A valid 3-item COST-S-C scale and its optimal cut-off point was developed. ConclusionsThe COST-S-C is a valid and quick screening tool used to distinguish patients with cancer who report significant financial toxicity in various medical settings.

Yoga-Based Interventions in Low-Income Populations: A Scoping Review.

Introduction: The popularity of yoga has surged in recent years; however, yoga practitioners have remained a largely homogenous population. Research reflects that most practitioners are of a higher socioeconomic status. There are access barriers to yoga for lower income individuals, likely due to factors such as financial constraints and logistical challenges. The primary goal of this review was to synthesize literature on yoga research among low-income populations and better understand the feasibility and acceptability of such interventions. A secondary goal was to assess the consistency of metrics for reporting feasibility and acceptability across such studies using the CheckList Standardizing the Reporting of Interventions for Yoga (CLARIFY) guidelines as a framework. Third, the authors sought to propose additional standardized CLARIFY guidelines that may enhance reporting on the diversity of yoga research populations, adherence, and retention. Methods: The electronic databases PubMed, PsycINFO, Cochrane Central Register of Controlled Trials, and Google Scholar were searched in May 2022 using a prespecified search string. Articles assessing a yoga intervention in predominantly low-income adult populations were deemed eligible for inclusion. Results: The search resulted in 512 potential articles. Eleven were deemed eligible for inclusion. The included studies reported mostly positive effects of yoga on the target outcome (i.e., pain/disability, quality of life/wellness, and psychiatric symptoms). Recruitment and retention data showed generally good attendance and high study completion rates. Common study design components included recruitment embedded within preexisting medical settings, proximal yoga locations, and mitigation of yoga-related costs. Finally, the authors noted inconsistency in the reporting of adherence, retention, and other sociodemographic characteristics of participants and yoga instructors (e.g., race, ethnicity, and income). Discussion: Yoga may promote physical and mental health for low-income individuals. Important facilitators to access are noted, such as proximal study settings, as well as barriers such as the need for childcare that can be addressed in future research. In addition, several study design considerations could help address the specific needs of low-income participants in yoga research, such as compensating participants, recruiting within existing medical settings, and providing yoga-related equipment at no cost. Finally, the authors suggest specific ways to enhance reporting of study metrics related to socioeconomic diversity, by adding to the preexisting CLARIFY guidelines.

Development of a 3D Vascular Network Visualization Platform for One-Dimensional Hemodynamic Simulation.

Recent advancements in computational performance and medical simulation technology have made significant strides, particularly in predictive diagnosis. This study focuses on the blood flow simulation reduced-order models, which provide swift and cost-effective solutions for complex vascular systems, positioning them as practical alternatives to 3D simulations in resource-limited medical settings. The paper introduces a visualization platform for patient-specific and image-based 1D-0D simulations. This platform covers the entire workflow, from modeling to dynamic 3D visualization of simulation results. Two case studies on, respectively, carotid stenosis and arterial remodeling demonstrate its utility in blood flow simulation applications.

A Cost-Effectiveness Analysis of Population-Level Dental Caries Prevention Strategies in US Children

ObjectiveTo improve oral health disparities and outcomes among US children impacted by dental caries, there is a need to understand the cost-effectiveness of a targeted, risk-based versus universal-based approach for caries prevention. MethodsHealth and economic outcomes were simulated in a cohort of 50,000 US children aged 1–18 years, comparing current practice (CP) to risk-based-prevention (RBP) and prevention-for-all (PFA) strategies using health care sector and limited societal perspectives. Prevention included biannual oral health exams and fluoride varnish application, and one-time dental sealant placement. The primary outcome is the cost-effectiveness ratio (ICER), defined as the additional cost per quality-adjusted life year (QALY) gained when comparing each strategy to the next least costly one. ResultsFor RBP compared to CP, the ICER was US$83,000/QALY from the health care sector perspective; for PFA compared to RBP the ICER was US$154,000/QALY. Using a limited societal perspective that includes caregiver time spent attending dental or medical setting visits, RBP compared to CP yielded a ratio of $119,000/QALY and PFA compared to RBP was $235,000/QALY. Results were most sensitive to changes in the probability of pain from an episode of dental caries, costs for prevention and restoration, and the loss in health-related quality of life due to dental caries pain. Scenario analyses evaluating a reduced intensity of prevention services yielded lower ICERs. ConclusionUsing a risk-based approach that identifies and targets children at increased risk for dental caries to guide the delivery of prevention services represents an economic value similar to other pediatric prevention programs.

Let's Chalk About It: Introducing the TinyTalks Curriculum, a Paradigm for Short, Virtual Chalk Talks.

In busy clinical environments, educational opportunities must be designed to accommodate learner-specific needs. Many adult learners prefer short, relevant, technology-enhanced learning. As such, electronic learning (e-learning) experiences have become a prominent part of medical education. Yet, there remain challenges to e-learning experiences in the current educational landscape. To address these challenges, the authors developed the TinyTalks paradigm, which serves as the educational foundation for the TinyTalks curriculum.The TinyTalks paradigm was developed using the existing e-learning literature and foundational principles of adult learning and related theories. The TinyTalks paradigm includes 3 ground rules: (1) all TinyTalks videos must identify a category (approach to, explanation of, or application of) to clarify the focus of the topic, (2) all TinyTalks videos must be less than 7 minutes with all material presented on one virtual chalkboard screen, and (3) all TinyTalks videos must use the hook, frame, and delivery model, which guides the creation of the video. The resulting TinyTalks curriculum is an online repository of short, chalk talk-style educational videos, developed by interdisciplinary health professionals and targeted to the level of trainees, that is available to be used flexibly by learners for just-in-time learning, flipped classroom sessions, and/or self-study.The authors used Kern's 6-step approach to curriculum development as the conceptual framework for the development and implementation of the TinyTalks curriculum at Mass General for Children (June 2021-January 2023). While developing and implementing the curriculum, the authors focused on topic selection, stakeholder recruitment, establishing a process flow, and creating a virtual home.The authors believe the TinyTalks paradigm outlines an effective educational strategy that accommodates the unique needs of both learners and teachers in the medical education setting. The next steps are to scale the TinyTalks curriculum up by expanding the content library and to evaluate its efficacy.

Disguise without Disruption: Utility-Preserving Face De-identification

With the rise of cameras and smart sensors, humanity generates an exponential amount of data. This valuable information, including underrepresented cases like AI in medical settings, can fuel new deep-learning tools. However, data scientists must prioritize ensuring privacy for individuals in these untapped datasets, especially for images or videos with faces, which are prime targets for identification methods. Proposed solutions to de-identify such images often compromise non-identifying facial attributes relevant to downstream tasks. In this paper, we introduce Disguise, a novel algorithm that seamlessly de-identifies facial images while ensuring the usability of the modified data. Unlike previous approaches, our solution is firmly grounded in the domains of differential privacy and ensemble-learning research. Our method involves extracting and substituting depicted identities with synthetic ones, generated using variational mechanisms to maximize obfuscation and non-invertibility. Additionally, we leverage supervision from a mixture-of-experts to disentangle and preserve other utility attributes. We extensively evaluate our method using multiple datasets, demonstrating a higher de-identification rate and superior consistency compared to prior approaches in various downstream tasks.