Pass Rate Research Articles

Coefficients of variation analyses of internal quality control status for blood lead in China from 2015 to 2023.

Blood lead test is widely conducted in Chinese laboratories, while the imprecision of blood lead measurement based on internal quality control (IQC) across China has not been comprehensively evaluated nowadays. Using the IQC data of blood lead collected through a web-based external quality assessment (EQA) reporting system, we analyzed current coefficients of variation (CVs) of blood lead from 2015 to 2023 among Chinese laboratories. Two allowable total error (TEa) imprecision levels from EQA were applied to calculate the pass rates, namely percentages of laboratories meeting precision quality specifications. Besides, CV values and pass rates by different subgroups were further performed to assess potential differences. Generally, median CV values significantly declined year by year from 6.8% in February 2015 to 5.9% in March 2023. The pass rates based on 1/3 TEa showed upward trends increasing from 15.3% in February 2015 to 20.0% in March 2023, but these percentages were non-ideal with less than 25%. No significant differences in CVs were found between tertiary hospitals and non-tertiary hospitals and between accredited and non-accredited laboratories. Significant time trends were observed in tertiary hospitals and nonaccredited laboratories. As for manufacturers, Bohui and self-made QC sample were most widely-used with obvious interannual declining trends of CVs. The CVs of blood lead demonstrated continuous overall improvements in the past twenty years. However, relatively lower pass rates indicated the non-ideal imprecision performance, and more proper performance specifications are warranted. Thus, imprecision improvement and ongoing investigation for blood lead IQC are still needed.

Successful 24-hour discharge for total knee arthroplasty: importance of timing of surgery and physiotherapy in enhanced recovery after surgery protocol.

The current literature is mixed on which patient factors, if any, predict the rate of successful discharge within 24 h of enhanced recovery after surgery (ERAS) total knee arthroplasty (TKA). This study aimed to investigate the influence of timing of surgery and physiotherapy on the rate of successful 24-h discharge. All 342 patients who underwent ERAS day surgery TKA from August 2020 to July 2021 were followed up prospectively. Patient characteristics and postoperative outcomes, such as number of physiotherapy sessions required before clearance for home, time taken after surgery to ambulate >10 m and length of stay (LOS), were recorded. Patients were grouped based on surgical end time (morning/afternoon/ evening) and time of physiotherapy review (morning/afternoon/evening/morning after). Patients successfully passed ERAS day surgery protocol if they were discharged within 24 h. With regard to the timing of operation, the morning group had the shortest LOS (P = 0.001) and a higher ERAS day surgery pass rate than the afternoon group (P = 0.016). With regard to the timing of physiotherapy, the afternoon group took the shortest time to ambulate >10 m (P < 0.001), had the shortest LOS (P < 0.001) and had a higher ERAS day surgery pass rate as compared to the morning after the operation group (P = 0.005). Patients who ended their operations in the morning and received physiotherapy review in the same afternoon were the most likely to be discharged within 24 h due to early ambulation and adequate time for spinal anaesthesia to wear off.

The Personal Faculty Mentor (PFM) Role: Advanced Support for Individualized Student Care

Background - Given the complexity of student responsibilities and backgrounds, the need for additional support during graduate education is evident for overall success. An innovative role that addresses these complexities and mitigates issues facing today’s nursing student was developed. Purpose - The Personal Faculty Mentor (PFM) role was developed to provide one, specific point of contact in an effort to support students throughout their MSN journey by completing new student orientation, individualized student outreach, frequent personal communication, and development of success plans. The PFM role also supports the faculty or instructor role by providing additional support and outreach with student concerns (low participation or scores). The overall purpose of the PFM is to improve student outcomes including pass rates, persistence rates, and satisfaction. Methods - Within the University’s Master of Science in Nursing Accelerated Track (MSN AT) Advanced Generalist and Clinical Nurse Leader (CNL), the PFM role was implemented to support student success. The MSN AT has flexible due dates for assignments which lends for more intensive student support. Results – Since the PFM role has been in place since program inception (July 2019), persistence and program completion are on average 12% higher, as high as 29%, with those students who actively participate with their PFM. Through survey, students report high satisfaction with the PFM role and attribute part of their success to this supportive role. Each session, students who actively participate with their PFM have better persistence than those who do not. Limitations – While the anecdotal feedback and positive outcomes are noteworthy, this strategy did not involve an empirical research investigation. As a result, a causative relationship may not be concrete. There is clearly an improvement in the retention and persistence of students who engage regularly with the PFM; however, there are additional variables that may be impacting the outcomes that would be helpful to identify. Conclusions / Implications for Practice - Student support promotes success. The role of the PFM provides individualized, student-centered support. Students who participate and interact with their PFM are more likely to be successful in the MSN AT.

A Tissue‐Equivalent, Reusable Dosimeter for 3D Verification of Radiotherapy

AbstractA new tissue‐equivalent, reusable material for dosimetric verification of radiotherapy is developed and characterized. The material comprises a hydrogel matrix containing copper‐doped lithium fluoride nanoparticles that exhibit optically stimulated luminescence (OSL). Using a laser light sheet and a sensitive camera equipped with appropriate filters, the OSL signal is read out layer by layer thus constructing the 3D dose distribution. The good tissue equivalence allows the new material to register the dose from a prescribed treatment plan as if delivered to a patient. Cubic dosimeters measuring 50 × 50 × 50 mm3 are developed and used to measure 3D dose distributions (from voxels measuring 0.8 × 0.8 × 1.0 mm3) with a statistical dose precision of 5% at 100 Gy dose levels. The spatial precision of offsets in dose gradients between planned and measured dose distributions is below the voxel size. A 3% / 3 mm gamma analysis between a prescribed treatment plan and the retrieved and corrected readout yields a pass rate of 89.5%. Light scattering within the dosimetric volume affects the dosimeter performance, indicating the potential for future improvements of spatial and dose precision. In conclusion, the dosimeter system shows high promise for future clinical validation of radiotherapy.

Non linear correlated random effects models with endogeneity and unbalanced panels

We present simple procedures for estimating non linear panel data models in the presence of unobserved heterogeneity and possible endogeneity with respect to time-varying unobservables. We combine a correlated random effects approach with a control function approach while accounting for missing time periods for some units. We examine the performance of the approach in comparisons with standard estimators using Monte Carlo simulation. We apply the methods to estimate the effects of school spending on student pass rates on a standardized math exam. We find that a 10% increase in spending leads to an approximately 2 percentage point increase in math pass rates.

P14.16.A IS A LINAC WITH A 5MM MLC WIDTH REALLY A BARRIER TO IMPLEMENTING A HIGH-QUALITY COMPLEX SRS SERVICE?

Abstract BACKGROUND Stereotactic Radiosurgery (SRS) for patients with intracranial disease is increasing, especially for smaller and more numerous metastases. In England, Varian HyperArc using a Truebeam linac is nationally commissioned via benchmarking. HyperArc contains SRS-specific optimisation and non-coplanar VMAT delivery and is an attractive option due to its cost effectiveness compared with competing specialised platforms such as Elekta GammaKnife and Accuray CyberKnife. Depsite these benefits, the treatment of small targets or those with highly complex shapes is dominated by specialised platforms with a largely stated reason being perceived concern over delivered dosimetric certainty. This work assesses achievable dosimetric accuracy for complex SRS using Varian HyperArc suing a standard 120-leaf 5mm width MLC. MATERIAL AND METHODS Four patients with small and/or complex PTVs previously treated with CyberKnife at our institution were identified:26 metastases 24Gy/1f (PTV min. volume 0.01cc);5 metastases 24 Gy/1f (PTV min. volume 0.11cc);Pituitary adenoma 25Gy/1f (PTV width min. 5 mm near optics);Acoustic neuroma 21 Gy/3f (PTV width min. 3 mm near cochlea). Patients were re-planned with HyperArc using 4 arcs at 6FFF, emulating the prescription dose spillage (PDS) &amp; modified gradient index (mGI) achieved in the CyberKnife plans. Plans were produced in Eclipse v17.1, calculated using the AAA algorithm (v 17.1.0.1) on a 1mm calculation grid. The plan was then transferred to a CT scan of an in-house water equivalent phantom containing radiochromic EBT3 film in clinically meaningful coronal and sagittal dose planes and re-calculated. All plans were delivered under image guidance and the 2D film dosimetry was compared with the calculated dose from Eclipse using a global 5%/1mm (TH 20%) gamma test using well-established absolute dose film methodology in Sun Nuclear SNC Patient (v 8.2). RESULTS In all cases, HyperArc had very similar plan quality to CyberKnife, with maximum dose gradients between 20-23% of prescription dose per mm beyond the PTV (up to 5.8Gy/mm). Up to 1mm geometric offset was permitted to allow for imaging localization &amp; film registration uncertainty in the analysis. Mean gamma pass rates were 93.3% pre-alignment and 98.5% post-alignment. CONCLUSION The very high gamma pass rates achieved in this novel work illustrate excellent delivered dose accuracy for high-quality SRS plans. The use of a radiochromic film dosimetry allows for the demonstration of such accuracy using a standard Truebeam linac without the use of a high-definition MLC even for the smallest and most complex SRS targets. This work enables us to re-think previously held beliefs around perceived dosimetric limitations of multi-arc VMAT with a 5 mm MLC width for the delivery of high-quality SRS. Removing this barrier could start to bridge the existing gap in worldwide SRS service provision for patients.

Dosimetric commissioning of a high-resolution CMOS 2D detector array for patient-specific QA of single-isocenter multi-target VMAT stereotactic radiosurgery.

Stereotactic radiosurgery (SRS) using the single-isocenter-multiple-target (SIMT) technique by volumetric modulated arc therapy is increasingly popular for treating multiple brain metastases. However, the complex nature of SIMT SRS necessitates rigorous patient-specific quality assurance (PSQA). This study presents a multi-institutional dosimetric commissioning of a high-resolution complementary metal oxide semiconductor (CMOS) 2D detector array, the myQA SRS device for SIMT SRS PSQA. Basic dosimetric properties such as dose-rate, field-size, energy and angular dependencies were characterized for the CMOS detectors. Additionally, gamma index analyses were performed between the measured dose and the films for nine simulated and clinical plans. The results showed that the CMOS detector was dose-rate, field-size, energy and beam-angle dependent. Specific to SIMT SRS, angular dependence on gantry rotations was invariant to couch rotations but was sensitive to off-isocenter distances. With appropriate dose calibration and angular corrections, myQA SRS showed a high dosimetric correlation with films. The average gamma index pass rates were 99.9 ± 0.03% and 99.2 ± 1.1% at 3%/2mm/10%thr(global) and 1mm/1%/10%thr(local) criteria, respectively. The average dose difference between myQA SRS and films was 0.4 ± 1.3%. In conclusion, the CMOS 2D detector array has demonstrated its potential as a reliable tool for PSQA for SIMT SRS. The excellent dosimetric agreement with the films was consistent in multiple institutions, further validating the dosimetric accuracy and reproducibility. It provides a timely alternative to film dosimetry for commissioning and quality assurance.

Utilizing acrylic acid polymer hydrogel for 3-D quality assurance in CyberKnife radiotherapy

Dosimetry tools play a crucial role in radiotherapy as they are essential for recording and validating intricate 3-D dose distributions. This research introduces and examines a novel acrylic acid polymer hydrogel (ACAPHG) dosimeter composition designed for 3-D dose verification and quality assurance in the context of radiotherapy treatment. A phantom made of an 80 mm diameter cylindrical glass container was utilized. The phantom contained the hydrogel, which served as the medium for radiation exposure. The water equivalent hydrogel within the phantom was subjected to irradiation by a CyberKnife robotic radiotherapy system. An optical computed tomography (OCT) scanner with sub-millimeter resolution was used to obtain imaging data. The dose distribution of a CyberKnife robotic SRS/SBRT treatment plan for a brain cancer patient was compared to that of the hydrogel's OCT scan using 2-D and 3-D gamma analysis with a criterion of 3% dose difference and 3 mm distance-to-agreement. A gamma pass rate of 94.1% for the 2-D gamma analysis and a pass rate of 99% for the 3-D gamma analysis were calculated within the region at which the treatment planning system data drops to 20% of the maximum dose. The use of the ACAPHG dosimeter in conjunction with the described setup suggests that it has the potential to offer an accurate 3-D verification of complex dose distributions in SRS/SBRT radiotherapy treatments. By employing the ACAPHG dosimeter and utilizing OCT scanning, this dosimeter enables the assessment and validation of intricate dose distributions in these advanced radiotherapy treatments.

Application of Information Link Control in Surgical Specimen Near-Miss Events in a South China Hospital: Nonrandomized Controlled Study.

Information control is a promising approach for managing surgical specimens. However, there is limited research evidence on surgical near misses. This is particularly true in the closed loop of information control for each link. A new model of surgical specimen process management is further constructed, and a safe operating room nursing practice environment is created by intercepting specimen near-miss events through information safety barriers. In a large hospital in China, 84,289 surgical specimens collected in the conventional information specimen management mode from January to December 2021 were selected as the control group, and 99,998 surgical specimens collected in the information safety barrier control surgical specimen management mode from January to December 2022 were selected as the improvement group. The incidence of near misses, the qualified rate of pathological specimen fixation, and the average time required for specimen fixation were compared under the 2 management modes. The causes of 2 groups of near misses were analyzed and the near misses of information safety barrier control surgical specimens were studied. Under the information-based safety barrier control surgical specimen management model, the incidence of adverse events in surgical specimens was reduced, the reporting of near-miss events in surgical specimens was improved by 100%, the quality control quality management of surgical specimens was effectively improved, the pass rate of surgical pathology specimen fixation was improved, and the meantime for surgical specimen fixation was shortened, with differences considered statistically significant at P<.05. Our research has developed a new mode of managing the surgical specimen process. This mode can prevent errors in approaching specimens by implementing information security barriers, thereby enhancing the quality of specimen management, ensuring the safety of medical procedures, and improving the quality of hospital services.

Development of an EGSnrc multi-leaf collimator component module and treatment head model for a low-field MRI linear accelerator.

Monte Carlo (MC) modeling of MR-guided radiotherapy (MRgRT) treatment machines enables the characterization of photon/electron interactions in the presence of a magnetic field. The EGSnrc MC code system is a well-established system for radiation dose calculations. The multi-leaf collimator (MLC) component modules presently available within the EGSnrc MC code system do not include a model of the double-focused MLC available on a low-field (0.35T) MRI linear accelerator (MR linac). Here we developed and validated a new component module (CM) for the low-field MRgRT MLC using the EGSnrc/BEAMnrc/DOSXYZnrc code system. We performed detailed modeling of the treatment head and validated the model using measurements and calculations from the vendor-specific treatment planning system (TPS). The detailed geometry of the low-field MR linac MLC and other treatment head structures were modeled using BEAMnrc. Comparisons of DOSXYZnrc simulated dose against measurements and the low-field MR linac TPS for a variety of AAPM TG-53 task group report suggested square and shaped fields, as well as a step-and-shoot intensity-modulated radiotherapy (IMRT) plan, are presented. Our model agrees with both measured and TPS calculated data on average within 2%/2mm (dose/DTA) criterion for square field profiles. Output factors agreed within 1% for field sizes down to 2.49×2.49cm2 and within 2% of TPS data for the smallest field size of 0.83×0.83cm2. Shaped field and IMRT MC calculations agreed with measured and TPS data such that the gamma pass rates (3%/2mm) were 99.5% and (3%/3mm) 96.2%, respectively. We developed and validated an MLC CM (SYNCVRMLC) for the low-field MR linac using the EGSnrc MC code systems. This new CM will facilitate MC computation of fluence and dose distributions using BEAMnrc/DOSXYZnrc for patients treated on the low-field MR linac.

A deep learning-based dose calculation method for volumetric modulated arc therapy

BackgroundVolumetric modulated arc therapy (VMAT) planning optimization involves iterative adjustment of numerous parameters, and hence requires repeatedly dose recalculation. In this study, we used the deep learning method to develop a fast and accurate dose calculation method for VMAT.MethodsThe classical 3D UNet was adopted and trained to learn the physics principle of dose calculation. The inputs included the projected fluence map (FM), computed tomography (CT) images, the radiological depth and the source-to-voxel distance (SVD). The projected FM was generated by projecting the accumulated FM between two consecutive control points (CPs) onto the patient’s anatomy. The accumulated FM was calculated by simulating the movement of the multi-leaf collimator (MLC) from one CP to the next. The dose, calculated by the treatment planning system (TPS), was used as ground truth. 51 head and neck VMAT plans were used, with 43, 1 and 7 cases as training, validation, and testing datasets, respectively. Correspondingly, 7182, 180 and 1260 CP samples were included in the training, validation, and testing datasets.ResultsThis presented method was evaluated by comparing the derived dose distribution to the TPS calculated dose distribution. The dose profiles coincided for both the single CP and the entire plan (summation of all CPs). But the network derived dose was smoother than the TPS calculated dose. Gamma analysis was performed between the network derived dose and the TPS calculated dose. The average gamma pass rate was 96.56%, 98.75%, 98.03% and 99.30% under the criteria of 2% (tolerance) -2 mm (distance to agreement, DTA). 2%-3 mm, 3%-2 mm and 3%-3 mm. No significant difference was observed on the critical indices including the max, mean dose, and the relative volume covered by the 2000 cGy, 4000 cGy and the prescription dose. For one CP, the average computational time of the network and TPS was 0.09s and 0.53s. And for one patient, the average time was 16.51s and 95.60s.ConclusionThe dose distribution derived by the network showed good agreement with the TPS calculated dose distribution. The computational time was reduced to approximate one-sixth of its original duration. Therefore the presented deep learning-based dose calculation method has the potential to be used for planning optimization.

Design and Testing of Key Components for a Multi-Stage Crushing Device for High-Moisture Corn Ears Based on the Discrete Element Method

To improve the crushing efficiency and crushing pass rate of high-moisture corn ears (HMCEs), a multi-stage crushing scheme is proposed in this paper. A two-stage crushing device for HMCEs is designed, and the ear crushing process is analyzed. Firstly, a simulation model for HMCEs was established in EDEM software (2018), and the accuracy of the model was verified by the shear test. Subsequently, single-factor simulation experiments were conducted, with the crushing rate serving as the evaluation index. The optimal working parameter ranges for the HMCE device were identified as a primary crushing roller speed of 1200–1600 revolutions per minute (r/min), a secondary crushing roller clearance of 1.5–2.5 mm, and a secondary crushing roller speed of 2750–3750 r/min. A Box–Behnken experiment was conducted to establish a multiple regression equation. With the objective of maximizing the qualified crushing pass rate, the optimal combination of parameters was revealed: a primary crushing roller speed of 1500 r/min, a secondary crushing roller clearance of 2.5 mm, and a secondary crushing roller speed of 3280 r/min. The pass rate of corn cob crushing in the simulation test was 98.2%. The physical tests, using the optimized parameter combination, yielded a qualified crushing rate of 97.5%, which deviates by 0.7% from the simulation results, satisfying the requirement of a qualified crushing rate exceeding 95%. The experimental outcomes validate the rationality of the proposed crushing scheme and the accuracy of the model, providing a theoretical foundation for subsequent research endeavors.

Construction and implementation of a laparoscopic skill training course based on a smartphone application and virtual reality

BackgroundTo develop a laparoscopic training course that combines a smartphone application (APP) and virtual reality (VR), and initially evaluate the feasibility and effectiveness of its implementation.MethodsThe Exploring Laparoscopy (Ex-Lap) app was developed to meet training demands. The course was designed by integrating the app with a VR simulator (LapSim®) and animal organ perfusion simulators. From January 2021 to December 2023, 91 participants were enrolled in the study and then divided into 5 separate batches to undergo the first stage of the course. The performance of the participants was evaluated by rating scale, the overall Training and Assessment of Basic Laparoscopic Techniques (TABLT) scores, and pass rates. Statistical analyses were conducted using SPSS 26.0, employing Kruskal-Wallis tests, Chi-squared analysis, and Fisher’s exact test, depending on the data type.ResultsThe Staged Training and Assessment of Laparoscopic Skills (STALS) course was developed, consisting of three stages. The overall pass rates for the first stage across the five batches ranged from 85 to 100%, with no significant difference (P = 0.387). No significant differences were found in the scale scores or TABLT scores for the training tasks among students from different batches (all P > 0.05).ConclusionsThe STALS course is applicable in residency training, demonstrating satisfactory teaching effectiveness and replicability.

Exploring the causes of variability in quality of oropharyngeal swab sampling for SARS-CoV-2 nucleic acid testing and proposed improvement measures: a multicenter, double-blind study.

Although coronavirus disease 2019 (COVID-19) has not been considered a public health emergency of international concern since last year, intermittent regional impacts still persist, and accurate testing remains crucial. Ribonuclease P protein subunit P30 (RPP30) RNA, known for its broad and stable expression in tissue cells, was used to evaluate samples from 10 hospitals with over 3,000 negative nucleic acid tests. The results revealed that the overall pass rate for the collected samples was consistently low and exhibited significant heterogeneity. After reassessing the evaluative effectiveness of RPP30 RNA Ct values from the samples of 132 positive individuals under quarantine observation, it was used to identify factors affecting sampling quality. These factors included different stages ranging from sample collection to PCR processing, various characteristics of both samplers and individuals being sampled, as well as sampling season and location. The results indicated that post-sampling handling had minimal impact, winter and fever clinic samples showed higher quality, whereas children's samples had lower quality. The key finding was that the characteristics of samplers were closely related to sampling quality, emphasizing the role of subjectivity. Quality control warnings led to substantial improvements, confirming this finding. Consequently, although there are various factors during the testing process, the most critical aspect is to improve, supervise, and maintain standardized practices among sampling staff.IMPORTANCEThis study further confirmed the reliability of internal references (IRs) in assessing sample quality, and utilized a large sample IR data to comprehensively and multidimensionally identify significant interference factors in nucleic acid test results. By further reminding and intervening in the subjective practices of specimen collectors, good results could be achieved.

Investigation of interfractional range variation owing to anatomical changes with beam directions based on water equivalent thickness in proton therapy for pancreatic cancer.

To assess the interfractional anatomical range variations (ARVs) with beam directions and their impact on dose distribution in intensity modulated proton therapy, we analyzed water equivalent thickness (WET) from 10 patients with pancreatic cancer. The distributions of the interfractional WET difference ($\Delta{\mathrm{WET}}^{\theta }$) across 360° were visualized using polar histograms. Interfractional ARVs were evaluated using the mean absolute error and ΔWET pass rate, indicating the percentage of $\Delta \mathrm{WE}{\mathrm{T}}^{\theta }$ < thresholds. The impact on dose distribution in proton therapy was evaluated based on two treatment plans for 40Gy(RBE)/5 fractions: 'Plan A', using two beam angles, in which the target was closest to the body surface among four perpendicular directions; and 'Plan B', using two beam angles with small ARVs. Analysis revealed individual variations in angular trends of interfractional ARVs. Three distinct trends were identified: Group 1 exhibited small ARVs around posterior directions; Group 2 exhibited small ARVs except ~60°; Group 3 demonstrated minimal ARVs only ~90°. In dose evaluation, while 150° and 210° were selected in Plan B for 9 out of 10 patients, for the remaining patient, 60° and 90° were chosen. Comparing dose volume histogram parameters for all patients, Plan B significantly reduced target coverage loss while maintaining organ-at-risk sparing comparable to Plan A. These results demonstrated that selecting beam angles with small interfractional ARVs for each patient enhances the robustness of dose distribution, reducing target coverage loss.

Association Between Pandemic-Related Instructional Delivery Modifications and Emergency Medical Technician (EMT) First Attempt Pass Rates

Background: The COVID-19 pandemic represents a sentinel event for healthcare and healthcare education alike. Mandatory shutdowns of educational institutions, combined with increased demand for skilled healthcare personnel, highlighted pre-existing challenges surrounding how to maintain a stable workforce. To ensure continuity of educational opportunities, many emergency medical services (EMS) educational institutions were forced to modify existing learning method to digital learning formats. This emergent transition unearthed concerns regarding the impacts alternative learning methods would have on entry-level EMS providers' learning outcomes and overall competency levels. The objective of this study was to investigate the impact of alternative instructional methods used for EMT education during the COVID-19 pandemic. Methods: The study is a retrospective review of prospectively collected data for EMT candidates from a single community college-based EMT program who completed a first attempt of the National Registry EMS Certification examination for EMT candidates from course sections ending between January 1, 2019, and December 31, 2020. Historical pre-COVID first attempt exam outcomes were compared to the first attempt outcomes of two alternative instructional methods –Emergency Remote (ER) and COVID Distance Learning Hybrid (DL). Results: The outcomes of 237 EMT students were evaluated. Remote and COVID Hybrid DL models compared to the traditional pre-COVID learning format. There was no significant difference in first attempt pass rates between students who participated in traditional learning, the Emergency Remote model (1.53 odds ratio), or the Distance Learning model (2.98 odds ratio). Conclusions: This study suggests that virtual learning is at least as effective as traditional formats in preparing students for the NREMT examination. Additional research is warranted regarding best practices for applying virtual learning modalities in EMS education.

The attrition, physical and insecticidal durability of two dual active ingredient nets (Interceptor® G2 and Royal Guard®) in Benin, West Africa: results from a durability study embedded in a cluster randomised controlled trial.

Studies evaluating the attrition, physical and insecticidal durability of dual active ingredient (AI) insecticide-treated nets (ITNs) are essential for makingprogrammatic decisions regarding their deployment. We performed a prospective study embedded in a cluster randomised controlled trial (cRCT) to evaluate the attrition, fabric integrity and insecticidal durability of Interceptor® G2 (alpha-cypermethrin-chlorfenapyr) and Royal Guard® (alpha-cypermethrin-pyriproxyfen), compared to Interceptor® (alpha-cypermethrin) in Benin. A total of 2428 study nets in 1093 randomly selected households in five clusters per arm of the cRCT were monitored for ITN attrition and fabric integrity every 6-12months post-distribution. Householders were further surveyed to investigate non-study net use and their preference for ITN fabric types used in the study nets. A second cohort of 120 nets per ITN type were withdrawn every 12months and assessed for chemical content and insecticidal activity in laboratory bioassays. Alpha-cypermethrin bioefficacy was investigated using the susceptible Anopheles gambiae Kisumu strain, and chlorfenapyr and pyriproxyfen bioefficacy were investigated using the pyrethroid-resistant Anopheles coluzzii Akron strain. Net pieces were tested in WHO cone bioassays and tunnel tests for alpha-cypermethrin and in tunnel tests for chlorfenapyr; pyriproxyfen activity was assessed in cone bioassays as the reduction in fertility of blood-fed survivors using ovary dissection. Bioefficacy was expressed as the proportion of ITNs passing predetermined WHO criteria, namely knock-down ≥ 95% or 24/72h mortality ≥ 80% or reduction in fertility ≥ 50%. Overall ITN survivorship was 52% at 24months and fell to 15% at 36months. Median ITN survival time was lower with Royal Guard® relative to Interceptor® [1.6 vs 2.3years; hazard ratio (HR) 1.49, 95% confidence interval (CI) 1.36-1.66; p < 0.001] and Interceptor® G2 (1.6 vs 2.1years; HR 1.33, 95% CI 1.20-1.47; p < 0.001). Householders overwhelmingly preferred polyester nets over polyethylene nets (96%), and more Royal Guard® nets were replaced with spare polyester nets from previous campaigns. All Royal Guard® nets passed efficacy criteria for alpha-cypermethrin at all time points (100%) while ITN pass rates after 24months had fallen to < 40% for pyriproxyfen and chlorfenapyr. The chemical content analysis showed a higher loss rate of the non-pyrethroid insecticides relative to the pyrethroids in each dual ingredient AI ITN; 74% vs 47% for Royal Guard® and 85% vs 63% for Interceptor® G2 at 36months. The median ITN survival time for Interceptor® G2 (2.1years) and Royal Guard® (1.6years) in Benin is substantially lower than 3years. Royal Guard® nets were discarded more quickly by householders, partly due to their low preference for polyethylene nets. The insecticidal activity of the non-pyrethroid insecticides in both dual AI ITNs was short-lived compared to alpha-cypermethrin. The results corroborate the findings from the cRCT conducted in Benin.

Clinical implementation and patient-specific quality assurance solutions for real-time target tracking and dynamic delivery in Radixact synchrony.

The installation and testing of the first Radixact with Synchrony system in Colombia marked a significant milestone in Latin America's medical landscape. There was a need to devise a robust quality assurance protocol to comprehensively evaluate both dose delivery and motion tracking accuracy. However, testing experiences under clinical conditions have not been extensively reported. Additionally, there are limited recommended measuring devices for Synchrony evaluation. To validate and implement an alternative setup for dynamic-PSQA while testing Synchrony's functionality under clinical scenarios, including real-patient motion traces, and to provide guidance to new centers undergoing clinical implementation of Helical Synchrony. This approach involves using the Iba miniPhantomR with strategically placed fiducial markers for configuring Gafchromic-films and array-based setups. When paired with the CIRS Dynamic Platform, this enables an innovative dynamic setup with trackable features for Synchrony delivery testing. Assessment scenarios, including compensation (M1S1) and no-motion compensation (M1S0), were evaluated using 2D-gamma pass rate analysis with multiple clinical gamma criteria. The Synchrony-Simulation feature was used to assess pre-treatment performance and capture the patient's target motion pattern. Synchrony for common clinical cases with patient's motion-traces was validated. The results for M1S0 and M1S1 demonstrated consistency with previous studies evaluating Synchrony functionality. Analysis using different gamma criteria unveiled dosimetric differences and impacts across various motion ranges. The application of effective kV-dose subtraction for array-based methods is of upmost importance when evaluating dynamic-PSQA with stringent gamma-criteria. However, no significant kV-dose impact on EBT3-Film was detectable. Two implemented configurations for dynamic-PSQA setups were validated and successfully integrated into our clinic. We addressed both the benefits and limitations of array-based and film-based methods. The functionality and limitations of Synchrony were evaluated using the proposed setups. The potential utility of Synchrony-Simulation, along with the proposed patient-case classification table, can offer valuable support for new users during the clinical implementation of Synchrony treatments.

Experimental assessment of the performance of artificial intelligence in solving multiple-choice board exams in cardiology.

The aim of the present study was to evaluate the performance of various artificial intelligence (AI)-powered chatbots (commercially available in Switzerland up to June 2023) in solving a theoretical cardiology board exam and to compare their accuracy with that of human cardiology fellows. For the study, a set of 88 multiple-choice cardiology exam questions was used. The participating cardiology fellows and selected chatbots were presented with these questions. The evaluation metrics included Top-1 and Top-2 accuracy, assessing the ability of chatbots and fellows to select the correct answer. Among the cardiology fellows, all 36 participants successfully passed the exam with a median accuracy of 98% (IQR 91-99%, range from 78% to 100%). However, the performance of the chatbots varied. Only one chatbot, Jasper quality, achieved the minimum pass rate of 73% correct answers. Most chatbots demonstrated a median Top-1 accuracy of 47% (IQR 44-53%, range from 42% to 73%), while Top-2 accuracy provided a modest improvement, resulting in a median accuracy of 67% (IQR 65-72%, range from 61% to 82%). Even with this advantage, only two chatbots, Jasper quality and ChatGPT plus 4.0, would have passed the exam. Similar results were observed when picture-based questions were excluded from the dataset. Overall, the study suggests that most current language-based chatbots have limitations in accurately solving theoretical medical board exams. In general, currently widely available chatbots fell short of achieving a passing score in a theoretical cardiology board exam. Nevertheless, a few showed promising results. Further improvements in artificial intelligence language models may lead to better performance in medical knowledge applications in the future.

Establishment and discussion of autoverification rules for transfusion compatibility testing.

To develop an automated verification workflow for transfusion compatibility testing (TCT) based on the AUTO10-A guidelines and blood group serology characteristics and to conduct a simulated validation of the test and subtest results by assessing the appropriateness of the autoverification rules. The accuracy of TCT results is a fundamental prerequisite for ensuring the safety of blood transfusions. However, the verification of these results still requires manual intervention. Five autoverification rules and their standards were determined: agglutination intensity, normal results, logical relationships, delta checks and interlaboratory test comparisons. The established categories and standards for the five rules were retrospectively validated using 13 506 samples (requests) that had been manually verified in our laboratory from January 2020 to June 2023. A total of 66 638 test items were involved in the autoverification, with 3844 items violating the verification rules, resulting in a pass rate of 96.10%. Considering individual test items, four tests had a pass rate of more than 90% in both the test item result table and the test subitem result table. However, there were significant differences in the pass rates between different tests. The same conclusion can be drawn when the unit is requests. The different standards set for the agglutination intensity and the delta check in the ABO typing testing subitems showed significant differences in pass rates. The incorporation of manually verified results into the automated verification simulation indicated that the five rules established in this study have good applicability, and appropriate standards can lead to reasonable pass rates.